DoDSER Department of Defense Suicide Event Report Calendar


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DoDSER Department of Defense
Suicide Event Report
Calendar Year 2019 Annual Report

The estimated cost of this report or study for the Department of Defense is approximately $94,000 in Fiscal Years 2020 - 2021. This includes $750 in expenses and $93,000 in DoD labor.

Generated on 2021 March 15

RefID: 0-0E15624

Calendar Year 2019 DoDSER Annual Report
If you or anyone you know is experiencing thoughts of suicide, please reach out for help immediately.
• Call 800-273-8255. If you’re a Service member or Veteran, press 1 to talk to a qualified Department of Veterans Affairs (VA) responder. • In Europe, call 00800 1273 8255 or DSN 118 • In Korea, call 0808 555 1188 or DSN 118 • In Afghanistan, call 00 1 800 273 8255 or DSN 111
• Start a confidential online chat session at www.VeteransCrisisLine.net/chat. • Send a text message to 838255 to connect to a VA responder. • If you are deaf or hard of hearing, you can connect through chat, text, or
teletypewriter (TTY).
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The Calendar Year 2019 DoDSER Annual Report
Psychological Health Center of Excellence Research and Development Directorate Defense Health Agency
The estimated cost of this report or study for the Department of Defense is approximately $94,000 for the 2020 and 2021 Fiscal Years. This includes $750 in expenses and $93,000 in DoD labor. Generated on 15 March 2021. RefID: 0-0E15624.
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Contents

Calendar Year 2019 DoDSER Annual Report

Table of Contents
Table of Contents ........................................................................................................................... iii Executive Summary ....................................................................................................................... iv Chapter 1: Introduction .................................................................................................................. 1 Chapter 2: Suicide Mortality Rates................................................................................................ 3 Chapter 3: DoDSER Summary - Joint Forces ............................................................................. 17 Chapter 4: DoDSER Summary - Active-Component U.S. Air Force.......................................... 36 Chapter 5: DoDSER Summary - Active-Component U.S. Army................................................ 39 Chapter 6: DoDSER Summary - Active-Component U.S. Marine Corps ................................... 42 Chapter 7: DoDSER Summary - Active-Component U.S. Navy ................................................ 45 Chapter 8: DoDSER Summary - Reserve Component ................................................................ 48 Appendix A: Section 741 NDAA FY20 Reporting Requirements .............................................. 58 Appendix B: Methods - DoDSER Data Processes ...................................................................... 66 Appendix C: Methods - Suicide Mortality Rates......................................................................... 70 Appendix D: Glossary.................................................................................................................. 76 Appendix E: Acronyms and Initialisms ....................................................................................... 81 Appendix F: List of Tables .......................................................................................................... 82 Appendix G: List of Figures ........................................................................................................ 84 Appendix H: Frequently Asked Questions (FAQs) ..................................................................... 85

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EXSUM

Calendar Year 2019 DoDSER Annual Report

Executive Summary
The Department of Defense Suicide Event Report (DoDSER) is the official reporting system for deaths by suicide and suicide attempts among Service members in the U.S. Air Force, Army, Marine Corps, Navy, and Space Force. The DoDSER Annual Report presents aggregated results generated from the DoDSER data collected by the Military Services during a specified calendar year. New for this year, the Calendar Year 2019 (CY19) DoDSER Annual Report also contains information in response to Section 741 of the National Defense Authorization Act (NDAA) for Fiscal Year 2020 (FY20), “Reports on Suicide among Members of the Armed Forces and Suicide Prevention Programs and Activities of the Department of Defense.” Section 741 required the Secretary of Defense to report on the total number of suicides, attempted suicides, and known cases of suicidal ideation among service members (including the reserve component) during a specified year; the number that occurred during the first 180 days of service along with the associated initial recruit training locations; and the number that occurred during a contingency operation deployment. The CY19 DoDSER Annual Report meets the requirements of Section 741 as described in Appendix A, “Section 741 NDAA FY20 Reporting Requirements.”
CY19 Suicide Mortality Rates
There were 344 deaths by suicide identified among active-component service members. The suicide mortality rate was 25.9 deaths per 100,000 population.
The suicide mortality rates for each active-component service were as follows:
• Air Force: 25.1 suicides per 100,000 population • Army: 29.8 suicides per 100,000 population • Marine Corps: 25.3 suicides per 100,000 population • Navy: 21.5 suicides per 100,000 population • Space Force: 0 suicides per 100,000 population (from establishment of Space
Force on December 20, 2019 through December 31, 2019)
The suicide mortality rates for the Reserve and the National Guard were 18.2 and 20.3 suicides per 100,000, respectively.
Military Suicide Mortality Rates over Time
For the active-component population, the data indicated a per-year increase in the suicide mortality rate ratio from CY11 to CY19. The reserve-component population and the National Guard population showed no interpretable per-year increases in their rate ratios from CY11 to CY19.
Comparison of Military Suicide Mortality Rates to the U.S. Adult Population
All changes observed in suicide mortality rates for the military populations for CY11-CY18 were consistent with the increase in the suicide mortality rate for the U.S. adult population over the same time frame. The comparison only extends through CY18 because CY19 data were not yet available for the U.S. population.

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EXSUM

Calendar Year 2019 DoDSER Annual Report

DoDSER Active Component Data Summary
• Firearm use was the most common method of injury cited in suicide DoDSER forms, accounting for 59.9% of all CY19 suicides.
• Drug and/or alcohol overdose was the most common method of attempted suicide cited in DoDSER forms, accounting for 53.1% of reported CY19 suicide attempts.
• Less than half (43.6%) of those who died by suicide in CY19 had a documented behavioral health diagnosis.
• Regardless of whether or not an individual voluntarily disclosed – or was assessed for – suicidal thoughts, feelings, or behaviors, approximately half (52.4%) of all individuals who died by suicide in CY19 made contact with the Military Health System (MHS) in the 90 days prior to death.
• The prevalence of various risk factors, protective factors, and other suicide event characteristics among suicide and suicide-attempt DoDSER forms in CY19 were generally consistent with levels observed for previous years.
DoDSER Reserve Component Data Summary
• Firearm use was the most common method of injury cited in CY19 suicide DoDSER forms for the Reserve (67.9%) and the National Guard (72.7%).
• Drug and/or alcohol overdose was the most common method of attempted suicide cited in CY19 DoDSER forms, accounting for 46.6% of reported suicide attempts for the Reserve and 44.8% of attempts for the National Guard.

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Introduction

Calendar Year 2019 DoDSER Annual Report

Chapter 1: Introduction
The Department of Defense Suicide Event Report (DoDSER) is the official reporting system for suicide events in the U.S. Air Force, Army, Marine Corps, Navy, and Space Force.1 All cases of suicide death and suicide attempt among military Service members are to be reported via the DoDSER.2 The Psychological Health Center of Excellence (PHCoE), a division of the Defense Health Agency Research and Development (J-9) Directorate, is responsible for the operation of the DoDSER, which has three primary elements:

1. A web-based system for collecting, organizing, and securing a standard set of case-level
data for every service member who dies by suicide or makes a suicide attempt, regardless
of military service, component, or duty status. The portal for the system is https://dodser.t2.health.mil/.1

2. A data-collection form that guides trained Military Health System (MHS) or commandlevel appointees on the data to assess and collect, as well as potential sources for required information. The content of the DoDSER form resulted from a collaborative process between the Military Services, civilian and military experts, senior military leaders, and key stakeholders. The form is periodically revised to reflect the evolving needs of each service; it currently contains more than 500 data elements. Table 1 displays the DoDSER form’s content areas.
Table 1. DoDSER form content areas

Content Area Personal Information Military Information Event Information Medical History Military History Personal History Narrative Summary

Variables and Types of Variables Age, sex, ethnicity, education, marital status Job code, duty status, permanent duty station Access to firearms, event method, event setting Behavioral health and medical history Deployment history, disciplinary action Developmental and family history, current stressors Information on data-collection strategy

3. An annual report of aggregated results generated from the data collected during a given calendar year. It is the culmination of collaborative efforts between PHCoE, the Suicide Prevention Program Offices of the Air Force, Army, Marine Corps, and Navy, the National Guard Bureau, the Defense Suicide Prevention Office, and the Armed Forces Medical Examiner System (AFMES).

To distinguish between these elements, the words system, form, or annual report appear after the DoDSER acronym throughout this report.

Interpretation of DoDSER Data
The reader is advised that this annual report’s descriptions of specific risk and contextual factors must not be interpreted as underlying causes of suicide. It is not possible to determine whether any variable is a risk factor for suicide solely from the data presented in this report. Identifying such relationships requires formal research that includes individuals who do not die by suicide or

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Introduction

Calendar Year 2019 DoDSER Annual Report

engage in a suicide attempt. This type of research is outside the surveillance function of the DoDSER system.
The reader should also take into account the content area of any given DoDSER item when interpreting results. While this report reflects the best data available, several items address contextual factors that may not be precisely determined using data from existing databases or from evidence collected following the event. As a result, these types of items include response options of “No Known History” and/or “Cannot Determine.” In this report, these response options are combined with “No” responses to differentiate them from “Yes” responses that indicate the existence of validating data or evidence. See Appendix B for more information about DoDSER data processes.
Special Note about the U.S. Space Force
The U.S. Space Force was established on December 20, 2019 within the Department of the U.S. Air Force. Given the date of establishment, the Space Force data for CY19 will be discussed in the Air Force chapter of this Report (see Chapter 4). All future DoDSER Annual Reports will have a chapter dedicated to the Space Force.

References and Notes
1. For more information on the DoDSER System, see the System of Record Notice (April 15, 2016, 81 FR 22240) at https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORNArticle-View/Article/570683/edha-20-dod
2. For more information on suicide death and attempt reporting via the DoDSER system, see DoD Instruction 6490.16, “Defense Suicide Prevention Program,” September 11, 2020 at https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/649016p.pdf?ver=202009-11-122632-850

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Suicide Mortality Rates

Calendar Year 2019 Annual Report

Chapter 2: Suicide Mortality Rates
This chapter first presents a primer on interpreting statistical data, which includes information about suicide mortality rate comparisons and a statistical measure of uncertainty, the confidence interval. The chapter then presents suicide mortality rate data for CY19 and the results of trend analyses of suicide mortality rates from CY11 through CY19. The chapter also presents results of comparisons between military and U.S. adult population rates for CY11 through CY18. For detailed information about the calculation of suicide rates, see Appendix C.
A Primer on Interpreting Statistical Data
Annual suicide mortality rates represent the number of deaths by suicide per 100,000 individuals from a specified population for a specified year. For example, a rate of 20 per 100,000 individuals means that 20 suicide deaths occurred for every 100,000 individuals in the population.
Suicide mortality rates can be compared 1) between different populations during the same time period or 2) within the same population over different time periods. Before undertaking any rate comparison, one must consider whether the populations differed from one another in a way that could make a comparison misleading. For example, men have a higher suicide mortality rate than women in the U.S. adult population and the U.S. military population has a higher proportion of men than women. A direct comparison of the suicide mortality rates between these populations would show that the U.S. military rate is higher. This rate difference can be attributed, at least in part, to the unequal proportions of men in each population. Rate standardization is one technique that can be used to remove important imbalances between populations. Appendix C provides more detail on how rate standardization can be accomplished.
Suicide mortality rates and comparisons between them are considered estimates. It is not possible to know the true values of rates or differences between rates. However, the data collected (i.e., observed data) provide the best estimate of the difference. The observed data are used to estimate a confidence interval (CI). A CI defines a range of values that may contain the true value. A 95% CI is an interval that has a 95% probability of containing the true value. The estimated value from the data is considered consistent with a true value contained within the interval, including the endpoints.1
As an example, if the annual suicide mortality rate for population A was 21 per 100,000 for year X and for population B was 18 per 100,000 for year X, then the corresponding rate ratio is 21/18=1.17. This means that the observed rate for population A was 17% greater than the observed rate for population B. The 95% CI for this comparison covers all values from 0.96 to 1.42. This means that the estimated ratio of 1.17 is consistent with a true ratio between 0.96 (or population A’s rate as 4% less than population B’s rate) and 1.42 (or population A’s rate as 42% greater than population B’s rate). Note that for rate ratios, a value of 1 indicates that there is no difference between the rates compared (e.g., 21/21=1). Accordingly, when a confidence interval for a rate ratio covers the value of 1, the observed data are consistent with a true value of 1 (i.e., no real difference between the rates).

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Suicide Mortality Rates

Calendar Year 2019 Annual Report

CY19 Suicide Mortality Rates by Military Population
Table 2 displays suicide mortality counts and rates by military population for CY19. Tables 3-9 provide suicide mortality counts and rates across demographic categories for each military population (active component, Reserve, National Guard) and for the active-component populations of each service. Per DoD policy, suicide mortality rates are not reported for populations with fewer than 20 events.2

Table 2. Frequency and rate of death by suicide for CY19, by military population

Population

No. Ratea

Active

344 25.9

Air Force

83 25.1

Army

142 29.8

Marine Corps

47 25.3

Navy

72 21.5

Reserveb

65 18.2

Air Force

13

--

Army

36 18.9

Marine Corps

9

--

Navy

7

--

National Guardb

89 20.3

Air

15

--

Army

74 22.3

aUnstandardized rate per 100,000 persons. Rates for subgroups

with fewer than 20 suicides are not reported because of statistical

instability. bRates for the Reserve and the National Guard include all service

members, irrespective of duty status.

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DoDSER Department of Defense Suicide Event Report Calendar