DEPARTMENT OF DEFENSE
UNDER SECRETARY OF DEFENSE
FOR PERSONNEL AND READINESS

ANNUAL SUICIDE
REPORT

 

 

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If you, or anyone you know, are experiencing thoughts of suicide, please reach
out for help immediately.

•

The Veterans and Military Crisis Line is a toll-free, confidential resource, with support
24/7, that connects Veterans, Service members, National Guard and Reserve, and their
family members with qualified, caring responders.

•

The Veterans and Military Crisis Line, text-messaging service, and online chat provide
free VA support for all Service members, including members of the National Guard and
Reserve, and all Veterans, even if they are not registered with VA or enrolled in VA
health care. All Service members, including members of the National Guard and
Reserve, along with their loved ones can call 1-800-273-8255 and Press 1, chat online
at https://www.veteranscrisisline.net/get-help/chat, or send a text message to 838255.

•

The Veterans and Military Crisis Line is staffed by caring, qualified responders from VA.
Many are Veterans themselves. They understand what Service members have been
through and the challenges that members of the military and their loved ones face.

•

Need crisis assistance while Overseas? The following overseas locations have direct
crisis line numbers:
o In Europe: Call 00800 1273 8255 or DSN 118
o In Korea: Call 0808 555 118 or DSN 118
o In Afghanistan: Call 00 1 800 273 8255 or DSN 111
o Crisis chat support is available internationally at
https://www.veteranscrisisline.net/get-help/chat

2

 Table of Contents
Executive Summary ...................................................................................................................................... 4
Introduction ................................................................................................................................................... 7
Service Member Suicide Data ...................................................................................................................... 8
Military Family Suicide Data...................................................................................................................... 16
Current and Future Departmental Efforts ................................................................................................... 19
Appendix A: Suicide Rates CY 2011-2018 ................................................................................................ 32
Appendix B: Common Suicide Misconceptions ......................................................................................... 35
Appendix C: Acronyms and Abbreviations ................................................................................................ 38
Appendix D: Terms and Definitions ........................................................................................................... 39
References ................................................................................................................................................... 43

3

 Executive Summary

WHAT IS THE ASR?
Effective January 1, 2019, the
Department of Defense (DoD)
Annual Suicide Report (ASR)
serves as the release authority
for the official annual suicide
counts and unadjusted rates for
the DoD. This report also
describes current and future
Departmental initiatives
underway to combat suicide
among Service members and
their families.
HOW DOES THE ASR
DIFFER FROM THE
DEPARTMENT OF
DEFENSE SUICIDE
EVENT REPORT ANNUAL
PUBLICATION?
The ASR provides a
mechanism for more timely
release of official annual DoD
suicide rates to the public.
This report focuses on recent
surveillance trends which
allow for the examination of
whether recent DoD policy or
programmatic initiatives are
having the desired effect. The
DoDSER Annual Report, first
published in 2008, continues to
provide critical interpretations
of military suicide data. The
DoDSER Annual Report is the
Department’s official source
for detailed risk and contextual
factors associated with suicide
and suicide-related behavior in
the DoD.

The Department of Defense (DoD) is committed to preventing
suicide within the military. Over the past decade, the
Department has made strides in establishing an infrastructure
for preventing military suicide by aligning our strategy with the
public health approach; establishing policy guidance and an
enterprise-wide suicide prevention governance body;
standardizing and advancing data surveillance, research, clinical
interventions, and program evaluation; and partnering and
engaging with other federal, non-profit, and private
organizations. There is still much more work to be done. In
October 2018, the Department established a requirement for a
DoD Annual Suicide Report (ASR) to serve as the official
source of annual suicide counts and unadjusted rates for the
DoD and a means by which to increase transparency and
accountability for DoD efforts towards the prevention of
suicide. This requirement also mandates the reporting of data
on suicide deaths among military family members. This firstever ASR presents recent suicide data on Service members and
their families, provides an overview of the Department’s suicide
prevention strategy and governance, and describes current and
future initiatives underway to combat suicide in the DoD.
Key findings reported in this ASR include the following:
In Calendar Year (CY) 2018, there were 541 Service
members who died by suicide. CY 2018 rates increased in
the Active Component over the last five years, while
remaining steady in the Reserve and National Guard during
this same timeframe. However, suicide rates were
consistent with rates from the past two years across all
Components (Active, Reserve, and National Guard). From
CY 2013 to 2018, the suicide rate for the Active Component
increased from 18.5 to 24.8 suicides per 100,000 Service
members. This increase was attributable to small increases in
the number of suicide deaths across all Services. The suicide
rates of the Reserve and National Guard remained steady across
this same timeframe. The CY 2018 suicide rate for the Reserve,
across Services and regardless of duty status, was 22.9 suicides
per 100,000 Reservists. For the National Guard, the suicide
rate, across Services and regardless of duty status, was 30.6
suicides per 100,000 members of the National Guard. For all

4

 WHAT WE FOUND
1. CY 2018 rates among
members of the Active
Component were
statistically consistent with
CY 2017 and CY 2016
rates. However, suicide
rates increased between
CY 2013 and 2018.
2. CY 2018 rates for the
Reserve and National
Guard were statistically
consistent with CY 2017
and CY 2016 rates.
Suicide rates remained
steady between CY 2013
and 2018.
3. Suicide rates in civilian
populations have increased
over time; the military is
showing similar trends.
4. Suicide rates for military
families, the Active
Component, and Reserve,
are comparable to U.S.
population rates after
accounting for age and
sex; National Guard rates
are higher than U.S.
population after similar
adjustments.
WAY FORWARD
Based on findings from the
ASR, the Department will use
a multi-faceted public health
approach to target areas of
greatest concern, specifically
young and enlisted members,
as well as National Guard
members, and continue to
support our military families.

Services and Components, CY 2018 suicide rates were consistent
with CY 2017 and CY 2016 rates.
After accounting for age and sex, military suicide rates were
roughly equal to rates in the U.S. population. The most recent
suicide data available for the U.S. population is for CY 2017. In
CY 2017, the suicide rate for the U.S. population, ages 17 to 59,
was 18.2 deaths per 100,000 individuals. At face value, the
suicide rate in the U.S. population appears to be lower than
military rates for all Components. However, the composition of
the military and U.S. population varies considerably by age and
sex — two factors with strong associations with suicide risk.
After controlling for differences in age and sex between these
populations, CY 2018 suicide rates in the military were roughly
equivalent to the U.S. population rates for all Components,
except the National Guard (PHCoE, 2019; DoD Suicide Event
Report data). 1
Service members who died by suicide were primarily enlisted,
less than 30 years of age, male, and died by firearm,
regardless of Component. In CY 2018, the distribution of
suicide deaths by demographic and military factors reflected the
profile of the Total Force. 2 Decedents were primarily enlisted,
male, and less than 30 years of age, regardless of Component;
this demographic makes up 46% of the military population, but
about 60% of military suicide decedents. Specifically, the
greatest proportion of suicide decedents were junior enlisted (E1E4: ranging from 46.8% to 60.5% of those who died by suicide
across Components), less than 30 years old (ranging from 65.2%
to 72.8% of those who died by suicide), and male (ranging from
90.1% to 93.5% of those who died by suicide), depending on
Component (i.e., Active Component, Reserve, or National
Guard). The majority of Service members died by firearm
(ranging from 60.0% to 69.6% of those who died by suicide,
across Components).
The Department estimates there were 186 reported suicide
deaths among military spouses and dependents in CY 2017,
the most recent data available on military family members.
Suicide rates for military spouses and dependents were
generally comparable to U.S. population rates after

1
The National Guard experiences unique challenges compared to other DoD Components, including geographic dispersion, significant time
between military activities, access to DoD/VA healthcare, and variance in programs and resources across the 54 U.S. states and territories.
2
In the current report, Total Force is defined as DoD Active and Reserve Component military personnel. In addition, the Reserve Component is
further limited to members of the Selected Reserve (SELRES).

5

 accounting for age and sex. For military spouses, the suicide rate in CY 2017 was 11.5 per
100,000 population. When examined by sex, the suicide rates for male and female spouses,
between the ages of 18 and 60, were 29.4 and 9.1 per 100,000 population, respectively. These
rates were comparable to the suicide rates for similar age (18 to 60 years) males and females in
the U.S. general population (28.4 and 8.4 per 100,000 population, respectively). The overall
suicide rate among military dependents (< 23 years of age) was 3.8 per 100,000 dependents. For
male dependents, the suicide rate in CY 2017 was 5.2 per 100,000. This rate was less than the
suicide rate for males (< 23 years) in the U.S. population (9.3 per 100,000). The suicide rate for
female dependents of Service members was not reported due to low counts. 3 The primary
method of suicide death for both military spouses and dependents in CY 2017 was firearm.
Current and Future Departmental Efforts
The Department is strongly committed to preventing suicides within our military community.
The health, safety, and well-being of our military community is essential to the readiness of the
Total Force. Any death by suicide is a tragedy. The DoD embraces a public health approach to
suicide prevention that acknowledges a complex interplay of individual-, relationship-, and
community-level risk factors. This approach focuses on reducing the suicide risk of all Service
members and their family members by attempting to address the myriad of underlying risk and
socio-demographic factors (e.g., reluctance towards help-seeking, relationship problems, access
to lethal means), while also enhancing protective factors (e.g., strong social connections,
problem-solving, and coping skills). The Department’s suicide prevention efforts are guided by
the Defense Strategy for Suicide Prevention (DSSP) - aligned to the National Strategy for
Suicide Prevention - and led by an executive-level, enterprise-wide governance body.
Findings of the CY 2018 ASR indicate an increase in suicide rates among the Active
Component, as well as higher than expected rates in the National Guard compared to the U.S.
population. Based on these results, the Department will not only focus on fully implementing
and evaluating a multi-faceted public health approach to suicide prevention, but will target our
military populations of greatest concern – young and enlisted Service members and members of
the National Guard – and enhance support to our military families. Among other initiatives, our
efforts will focus on helping our young and enlisted Service members develop and enhance
foundational skills to deal with life stressors early in their military career, as well as recognize
and respond to suicide warning signs on social media. For the National Guard members, the
Department will work to increase accessibility to mental health care in remote areas, in
partnership with the Department of Veteran Affairs, through Mobile Vet Centers during drill
weekends, as well as implement the new Suicide Prevention and Readiness for the National
Guard (SPRING) initiative. The Department will also continue to support military families by
piloting and implementing initiatives to increase awareness of risk factors for suicide, safe
storage of lethal means (firearms and medications), and how to intervene in a crisis.
This first-ever ASR is reflective of the Department’s efforts to increase transparency and
frequency of reporting with respect to military suicides. This ASR also marks the first time the
3

Per DoD Instruction (DoDI) 6490.16, suicide rates are not reported for groups with fewer than 20 suicides due to statistical instability.

6

 Department has reported on military family member suicides. This increased transparency and
accountability will strengthen our program oversight and policies and assist the Department in its
commitment to prevent this tragedy by ensuring the health, safety, and well-being of our Service
members and their families.

Introduction
Suicide is the culmination of complex interactions among biological, social, and psychological
factors operating at the individual, community, and societal levels. In recognition of this
complexity, the Department of Defense (DoD) continues to implement a comprehensive public
health approach to suicide prevention. This report will discuss the recent history of suicide
prevention within the Department, present recent data, and describe DoD efforts to combat
suicide among Service members and their families.
Defense Suicide Prevention Office
In response to rising suicide rates in the DoD, a congressionally-mandated Task Force was
established in 2009 to study the issue of suicide in the U.S. military across all branches of
Service and to present their findings and recommendations to the Secretary of Defense. In
August 2010, the DoD Task Force on the Prevention of Suicide by Members of the Armed
Forces published a report on how the DoD could more effectively prevent suicide. One of the
Task Force’s first recommendations was the development of an office within the Office of the
Secretary of Defense to provide policy standardization and centralized data surveillance for
suicide prevention. In 2012, the Defense Suicide Prevention Office (DSPO) was established as a
direct result of this recommendation. DSPO advances holistic, data-driven suicide prevention in
our military community through policy, oversight, and engagement to positively impact
individual beliefs and behaviors, as well as instill systemic culture change. DSPO actively
engages and partners with the Military Services, other governmental agencies, non-profit
organizations, and the broader community to support Service members and foster a climate that
reduces stigma and promotes help-seeking.
Purpose of this Report
The DoD ASR satisfies reporting requirements established by the Office of the Under Secretary
of Defense for Personnel and Readiness in October 2018, requiring DSPO to produce an annual
report that serves as the official release authority for annual suicide counts and unadjusted rates
for the DoD, while also including information about DoD efforts and initiatives towards the
prevention of suicide in the military. This report also provides suicide data on military family
members per section 567 of the Carl Levine and Howard P. “Buck” McKeon National Defense
Authorization Act (NDAA) for Fiscal Year (FY) 2015. Data and input for this report were
obtained from many sources, including the Armed Forces Medical Examiner System
(AFMES), Military Departments, Defense Health Agency (DHA) Psychological Health Center
of Excellence (PHCoE), Defense Manpower Data Center (DMDC), and Centers for Disease
Control and Prevention (CDC).
7

 Service Member Suicide Data
To ensure reliability and comparability of surveillance data, clear and consistent terminology
with standardized definitions are required. In 2017, the DoD adopted the CDC’s
recommendations on uniform surveillance definitions for self-directed violence and codified
these definitions into policy. In accordance with DoD Instruction (DoDI) 6490.16 “Defense
Suicide Prevention Program,” the Department defines suicide as “death caused by self-directed
injurious behavior with an intent to die as a result of the behavior” (CDC, 2011). 4,5
Suicide Death Reporting in the DoD
The Department reports both counts and rates of suicide deaths in the DoD. Suicide counts are
useful for understanding the absolute magnitude associated with suicide mortality. However,
absolute numbers do not account for differences in population size; and, thus, cannot be used to
compare the number of deaths across groups, or within a single group, over time. Rates account
for differences in population sizes; and, as such, can provide a more standardized way to make
comparisons. 6 In the current report, suicide rates for the Active Component and members of the
Selected Reserve (SELRES) are calculated by AFMES in accordance with DoDI 6490.16. 7, 8
Suicide rates are reported per 100,000 Service members for ease of interpretation and as aligned
with industry standards (Stone et al., 2018).
Variability in Suicide Rate Determinations
In the current report, per industry standards, 95% confidence intervals are presented to account
for random error associated with suicide rate estimation. A potential source of random error is
the misclassification of a suicide (in either direction) due to variation or uncertainty that exists in
the manner-of-death determination process. 9 Confidence intervals provide a range of possible
values for the suicide rate that account for uncertainty due to random error. This range includes
the true value of the suicide rate with 95% confidence. Stated another way, one can be 95%
confident that the true suicide rate lies within this range of values. For comparisons of rates
across years, two rates are considered to be statistically different if their 95% confidence
intervals do not overlap. 10

4

While the Department defines suicide according to this standard, suicidal intent is rarely known. As such, medical examiners and coroners, both
internal and external to DoD, must use other criteria to determine manner of death.
5
The establishment of "intent" in manner of death determinations can be difficult and often varies due to differences in state and/or local laws,
inconsistent training of medical examiners and corners, and vague guidelines and/or operational criteria for determining suicide.
6
Rates are defined as the total number of suicides divided by the population at risk for a given time period. Rates are necessary, but not always
sufficient, for making comparisons across time or groups. Adjustment for demographic and other factors may be required for valid comparisons.
7
AFMES is responsible for verifying and reporting all active duty suicide deaths. For non-activated members of the SELRES, suicide deaths are
determined by civilian medical and legal authorities and reported to AFMES via the Military Services.
8
Per AFMES guidelines, Service members determined to be absent without leave (AWOL) at time of death are not included in official DoD
suicide counts and rates.
9
Suicide is particularly subject to inaccurate determination. At times, a death cannot be classified as a suicide due to a lack of evidence of intent.
10
When 95% confidence intervals do not overlap, rates are considered statistically different. However, the opposite is not always true (i.e., two
rates with overlap could potentially be significant, particularly when the amount of overlap is small).

8

 CY 2018 Service Member Data Summary
The section below summarizes annual suicide counts and unadjusted rates (per 100,000
population) for the Active Component, Reserve, and National Guard for CY 2016 - 2018 (Table
1). Data for CY 2018 include all known or suspected suicides (both confirmed and pending) as
of March 31, 2019, for both the Active and Reserve Components. 11 In accordance with DoDI
6490.16, rates are not reported when the number of suicide deaths is under 20.
Table 1. Annual Suicide Counts and Rates per 100,000 Service members by DoD Component
and Service, CY 2016 - 20181-3
DoD Component/Service
Active Component
Army
Marine Corps
Navy
Air Force
Reserve
Army Reserve
Marine Corps Reserve
Navy Reserve
Air Force Reserve
National Guard
Army National Guard
Air National Guard
1.
2.
3.

CY 2016
Count
Rate
280
21.5
130
27.4
37
20.1
52
15.9
61
19.4
80
22.0
41
20.6
19
-10
-10
-122
27.1
108
31.3
14
--

CY 2017
Count
Rate
285
21.9
114
24.3
43
23.4
65
20.1
63
19.6
93
25.7
63
32.1
10
-9
-11
-133
29.8
121
35.5
12
--

CY 2018
Count
Rate
325
24.8
139
29.5
58
31.4
68
20.7
60
18.5
81
22.9
48
25.3
19
-11
-3
-135
30.6
118
35.3
17
--

Source(s): AFMES.
Suicide rates for the SELRES include all Service members irrespective of duty status.
Per DoDI 6490.16, rates for groups with fewer than 20 suicides are not reported due to statistical instability.

CY 2018 Suicide Counts and Rates
There were 541 confirmed or pending suicide deaths for CY 2018. There were 325 suicide
deaths among Service members in the Active Component, 81 deaths in the Reserve, and 135
deaths in the National Guard, respectively.
The CY 2018 suicide rate in the Active Component was 24.8 suicide deaths per 100,000 Service
members. Across the Military Services, suicide rates ranged from 18.5 to 31.4 per 100,000
Active Component Service members. For the Reserve and National Guard, the rates were 22.9
and 30.6 suicide deaths per 100,000 Service members, respectively. The suicide rate in the
Army Reserve was 25.3 suicide deaths per 100,000 Reservists, and the rate for the Army
National Guard was 35.3 suicide deaths per 100,000 National Guard members. Per DoD policy,
all other Service-specific CY 2018 rates for Reserve and National Guard were not reported due
to low counts. Note that the CY 2018 rates were consistent with CY 2016 and CY 2017 rates for
all Services and Components.
11
The Department considers both confirmed and pending (or suspected) suicide deaths as “suicides” to reduce the potential for underestimating
the extent of suicide mortality in the DoD.

9

 Suicide Rates Over Time: Active Component
Longitudinal suicide trends for CY 2018 and the preceding five years (CY 2013-2017) are
presented below. The ASR focuses on recent surveillance trends (current year plus the previous
five years). This approach allows for examination of whether more recent DoD policy or
programmatic initiatives are having the desired effect and also reflects the time period most often
of greatest focus of Congressional and media inquiries. For a longitudinal assessment of suicide
trends in the DoD beginning in CY 2011, refer to Appendix A. 12 The Active Component
suicide rate, across all Services, statistically increased from CY 2013 to 2018 (18.5 to 24.8 per
100,000 population; Figure 1). This increase was attributable to an increase in the number of
suicide deaths across all Services. Note that the rates shown are unadjusted, as there were no
significant changes in age and sex in the Active Component over time. 13
Figure 1. Active Component Suicide Rates per 100,000 Service Members by CY1-3

1.
2.

3.

Source(s): AFMES
Statistically significant increases in rates over time, if present, are indicated by an upward arrow. A
statistically significant change in suicide rates over time (CY 2013-2018) was determined by a p-value
< 0.05.
The 95% confidence interval (indicated by gray bars) represents the range in which the true suicide rate
falls with 95% certainty.

12

Note that statistically significant trends may shift depending on the time frame selected for analysis.
Alternate statistical models were run that adjusted for age and sex. No differences were observed between unadjusted and adjusted models;
therefore, unadjusted rates are presented in this report.
13

10

 Suicide trends for each Military Service in the Active Component are provided in Figure 2 (AD). The Navy experienced a statistically significant increase in suicide rates between CY 2013
and CY 2018 (12.7 to 20.7; Figure 2C). While no statistically significant increases were
identified for the other Services over this period, the overall increase in the Active Component
was attributable to small increases in the number of suicide deaths across all Services.
Figure 2. Active Component Suicide Rates per 100,000 Service Members by CY1-3

1.
2.
3.

Source(s): AFMES.
Statistically significant increases in rates over time, if present, are indicated by an upward arrow. A statistically significant change in
suicide rates over time (CY 2013-2018) was determined by a p-value < 0.05.
The 95% confidence interval (indicated by gray bars) represents the range in which the true suicide rate falls with 95% certainty.

11

 Suicide Rates Over Time: Reserve and National Guard
The suicide rate was steady for both the Reserve and National Guard between CY 2013 and CY
2018 (i.e., no statistical change; Figure 3A/3B). When examined by Service, suicide rates were
steady over time for the Army Reserve and statistically increased for the Army National Guard.
Rates for the Marine Corps, Navy, and Air Force Reserve, as well as the Air National Guard, are
not reported due to low counts (per DoD policy). 14
Figure 3. Reserve and National Guard Suicide Rates per 100,000 Service Members by CY1-4

1.
2.
3.
4.

14

Source(s): AFMES.
Per DoDI 6490.16, rates for subgroups with fewer than 20 suicides are not reported due to statistical instability.
Statistically significant increases in rates over time, if present, are indicated by an upward arrow. A statistically significant change
in suicide rates over time (CY 2013-2018) was determined by a p-value < 0.05.
The 95% confidence interval (indicated by gray bars) represents the range in which the true suicide rate falls with 95% certainty.

Per DoDI 6490.16, rates are not reported when the number of suicides is less than 20 due to statistical instability.

12

 Demographic and Military Profile of Suicide Deaths
The demographic profile of Service members who died by suicide in CY 2018 was similar across
the Active Component, Reserve, and National Guard (Table 2) and reflected the profile of the
Total Force. 15 The majority of suicide decedents in CY 2018 were enlisted (ranging from 91.1%
to 93.3% of those who died by suicide across Components), specifically junior enlisted (E1-E4;
ranging from 46.8% to 60.5% of those who died by suicide). The majority of Active
Component, Reserve, and National Guard suicide decedents were under the age of 30 (67.1%,
72.8%, and 65.2% of those who died by suicide, respectively). The majority of decedents were
also male (ranging from 90.1% to 93.5% of those who died by suicide) and white (ranging from
69.1% to 81.5% of those who died by suicide) across the Active Component, Reserve, and
National Guard.
Table 2. Suicide Counts and Percentages, CY 20181-2
Active Component
Count
Percent
Sex
Male
Female
Total
Age Group
17-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
Total
Race
White
Black/African American
American Indian/Alaska Native
Asian/Pacific Islander
Other/Unknown
Total
Rank
E1-E4
E5-E9
O (Commissioned Officer)
W (Warrant Officer)
Total
1.
2.

Reserve
Count
Percent

National Guard
Count
Percent

304
21
325

93.5%
6.5%
100%

73
8
81

90.1%
9.9%
100%

125
10
135

92.6%
7.4%
100%

9
135
74
45
38
16
7
0
1
325

2.8%
41.5%
22.8%
13.8%
11.7%
4.9%
2.2%
0%
0.3%
100%

3
29
27
8
5
5
3
1
0
81

3.7%
35.8%
33.3%
9.9%
6.2%
6.2%
3.7%
1.2%
0%
100%

10
41
37
13
16
9
7
0
2
135

7.4%
30.4%
27.4%
9.6%
11.9%
6.7%
5.2%
0%
1.5%
100%

234
42
2
23
24
325

72.0%
12.9%
0.6%
7.1%
7.4%
100%

56
16
2
2
5
81

69.1%
19.8%
2.5%
2.5%
6.2%
100%

110
14
1
2
8
135

81.5%
10.4%
0.7%
1.5%
5.9%
100%

152
144
28
1
325

46.8%
44.3%
8.6%
0.3%
100%

49
26
5
1
81

60.5%
32.1%
6.2%
1.2%
100%

72
54
9
0
135

53.3%
40.0%
6.7%
0%
100%

Source(s): AFMES.
Per DoDI 6490.16, rates for subgroups with fewer than 20 suicides are not reported due to statistical instability.

15
Total Force includes DoD Active and Reserve Component military personnel. Reserve Component is further limited to members of the
Selected Reserve (SELRES).

13

 Method of Suicide Death
The most common methods of suicide death in CY 2018 across the Active Component, Reserve,
and National Guard were firearms, followed by hanging/asphyxiation (Table 3). 16 The
frequency of suicide deaths by these methods have not significantly changed over time (i.e., CY
2013 to 2018). Less than 3% of all suicide deaths (Active Component, Reserve, and National
Guard combined) in CY 2018 were attributable to drugs and/or alcohol.
Table 3. Method of Suicide Death by Component, CY 20181, 2
Active Component
Reserve
Method of Death
Count
Percent
Count
Percent
Firearm
195
60.0%
50
61.7%
Hanging/Asphyxiation
92
28.3%
15
18.5%
Drugs/Alcohol
3
0.9%
3
3.7%
Sharp/Blunt Object
12
3.7%
1
1.2%
Poisoning
4
1.2%
3
3.7%
Falling/Jumping
1
0.3%
0
0%
Other
3
0.9%
2
2.5%
Pending/Unknown
15
4.6%
7
8.6%
Total
325
100%
81
100%
1.
2.

National Guard
Count
Percent
94
69.6%
21
15.6%
6
4.4%
0
0%
0
0%
0
0%
3
2.2%
11
8.1%
135
100%

Source(s): CY 2018 method of death data obtained from AFMES for active duty Service members; method of death data for non-duty status
Reserve and National Guard obtained from the Military Services.
The poisoning category includes deaths unrelated to drug overdose, such as carbon monoxide poisoning.

Additional Key Facts Regarding Service Member Suicide
Suicide Rate Comparisons between the Military and U.S. General Population
The Department is often asked to describe how suicide rates in the military compare to those in
the U.S. general population. 17 While the Department recognizes unique differences between the
U.S. population and the military population, such comparisons can assist in identifying how the
military may reflect patterns seen in the civilian population, and how promising initiatives and
interventions may be applicable to military members and families. With that in mind, it is a
common misconception that military suicide rates are much higher than the U.S. general
population (see Appendix B: Common Suicide Misconceptions, #1). 18 In CY 2017, the
suicide rate for the U.S. population, ages 17-59, was 18.2 deaths per 100,000 individuals. 19 By
comparison, the suicide rate in the military in CY 2017 ranged from 21.9 in the Active
Component to 29.8 in the National Guard. On the surface, suicide in the military appears to be
16

In CY 2017, approximately 90% of active duty Service members who died by firearm suicide used a personally-owned firearm (as opposed to a
military-issued firearm; DoDSER Annual Report, CY 2017).
Any increases in suicide rates in the military population is likely correlated and/or connected with increases in the U.S. population. As Service
members are selected from the U.S. population, they are not necessarily exempt from broader suicide trends in the U.S. population.
18
Suicide rates calculated for the U.S. population are often incorrectly cited as “civilian” rates. However, a true “civilian” rate is unable to be
accurately calculated at this time, in part, due to difficulties associated with U.S. state and local authorities correctly identifying the military status
of deceased individuals. As a result, CDC civilian rates include Service members and Veterans.
19
The most recent data for the U.S. population at the time of this report is for CY 2017.
17

14

 markedly higher than the U.S. population—the rate is at least 48% higher depending on
Component. Nevertheless, the direct comparison of military suicide rates and the U.S.
population is misleading. It is well established that males have nearly four times higher risk of
suicide death than females. 20 As the U.S. military is comprised of a higher percentage of males
(85%) compared to the U.S. population (49.2%; Howden & Meyer, 2011), it is not surprising
that the suicide rate is higher in the military. Age is another demographic factor that is
associated with suicide risk and also varies substantially between the military and U.S.
population. The U.S. military is made up of a higher percentage of younger individuals (mean
age = 28.5) than the U.S. population (mean age = 41.3). Given the differences in composition
between the U.S. military and general population, any comparison of suicide rates must therefore
first account for age and sex. After accounting for these factors, the CY 2018 military suicide
rates were roughly equivalent to CY 2017 U.S. population rates for all Components, except the
National Guard (PHCoE, 2019; DoD Suicide Event Report data; Appendix A). 21,22,23
Additional Common Suicide Misconceptions and Facts
There are a number of common misconceptions about military suicide rates, which can often
distract from critical conversations about how to prevent suicide in military populations. Beyond
the common misconception that military suicide rates are much higher than the U.S. general
population, other common misconceptions are that: 1) deployment increases suicide risk among
Service members; 2) the majority of Service members who die by suicide had a mental illness;
3) removing access to one lethal means will cause someone at risk for suicide to replace it for
another; and 4) talking about suicide will lead to suicide. Appendix B provides information to
help clarify these common suicide misconceptions.
While an in-depth examination of the risk and contextual factors associated with suicide is
beyond the scope of this report, it is prudent to highlight a few additional factors that may
contribute to military deaths by suicide. 24 Prior DoD suicide surveillance reports and other
military-focused research highlight a number of risk factors that are associated with military
deaths by suicide, including: relationship, financial, and legal/administrative problems;
ineffective life/coping skills; and reluctance to seek help and perceived stigma to engage in
suicide care/treatment.
While the DoD and civilian populations share challenges in preventing suicide, many factors
found to increase risk for suicide are distinct to military populations as compared to civilian
populations, including Veterans. However, many of these risk factors are shared across
populations. Relationship stressors, such as failed or failing intimate partner relationships, are
frequently cited risk factors for suicide (LeardMann et al., 2012). In the military, failed or failing
relationships in the 90 days prior to death were reported in 36.9% of active duty suicides in CY
20

Centers for Disease Control and Prevention (CDC). Web-based Injury Statistics Query and Reporting System (WISQARS). Available from
http://www.cdc.gov/injury/wisqars/index.html. Most recent year data is available is 2017.
21
Comparisons between the military and U.S. population are reported annually in the DoDSER Annual Report. For detailed methodology related
to the calculation of these adjusted rates, please see the most recent report (CY 2017).
22
The National Guard faces unique challenges including geographic dispersion, significant time between military activities, DoD/VA healthcare
eligibility and access to care, and variance in programs and resources across the 54 U.S. states and territories.
23
The most recent data for the U.S. population at the time of this report is for CY 2017.
24
For a detailed examination of these contextual factors, please refer to the most recent DoDSER Annual Report (CY 2017).

15

 2017 (Pruitt, Smolenski, Tucker, et al., 2019). Research studies on military suicides and related
behaviors also indicate that for some individuals, financial stress, in combination of other factors
(e.g. relationship issues, mental health problems) can increase vulnerability for suicide (Goodin,
et al., 2019; Turunen & Hiilamo, 2014; Ursano, Fullerton, & Dichtel, 2016). When examining
surveilleinace data on military suicide, financial difficulties, including excessive debt and
bankruptcy in the 90 days prior to death, were reported for 7.4% of active duty Service members
who died by suicide (Pruitt, Smolenski, Tucker, et al., 2019). Moreover, approximately 30% of
active duty Service members who died by suicide had administrative or legal difficulties (e.g.,
article 15, administrative separations, medical evaluation board proceedings, civil legal
proceedings) in the 90 days prior to death (Pruitt, Smolenski, Tucker, et al., 2019). As noted
earlier, military suicide is very complex and there is always an interaction of many interrelated
factors for each suicide (Knox & Bossarte, 2012).
Also, of note, approximately one-half (51.5%) of Service members who died by suicide received
some form of care (though not necessarily suicide- or behavioral health-related care) via the
Military Health Service (MHS) in the 90 days prior to death (Pruitt, Smolenski, Tucker, et al.,
2019). Although it is not known whether these individuals were suicidal at the time of contact,
these contacts could represent opportunities for identification and treatment of suicidal risk. The
Department collects detailed information on all of these factors via the DoDSER system; this
additional data will be included in the forthcoming 2018 DoDSER Annual Report.

Military Family Suicide Data
Section 567 of the NDAA FY15, requires the DoD to collect, account, and assess any death that
is determined to be a suicide involving a military family member (as defined in Title 10, U.S.
Code). When the NDAA FY15 was enacted, the Department did not have an enterprise-wide
capability to collect and analyze information on deaths among military family members. The
majority of military family members are civilians whose deaths do not occur on a military
installation. As a result, the Department does not have visibility on, or jurisdiction over, these
deaths and must seek out other ways to obtain this information.
To address this challenge, the Department has been developing a process to collect and analyze
data on suicide deaths of military family members. No single source provides a full accounting
of suicide deaths among military family members; as such, a combined approach ensures that the
Department is capturing the most complete information on military family member deaths as
possible. The current DoD strategy employs a multi-pronged approach that leverages both
military data and civilian data from the following sources: 1) Defense Enrollment Eligibility
Reporting System (DEERS); 2) Military Services; and 3) CDC National Center for Health
Statistics (NCHS) National Death Index (NDI). 25,26,27 The latter data source, the NDI, is

25
In CY 2016, modifications were made to DEERS to allow manner of death to be captured when Service members provide death certificates of
their family members via their Real-Time Automated Personnel Identification System (RAPIDS) station.
26
Service members must submit family member death certificates to the Services’ Casualty Offices to receive Family Service members' Group
Life Insurance (FSGLI) benefits.
27
The Air Force Office of Special Investigations (OSI) also collects information on military family member deaths.

16

 currently available for CY 2017 only. As such, the data presented in this report reflect counts
and rates for military families and dependents from CY 2017.
Note that the completeness of military family member death data rely to a large extent on the
ability of the Department to capture comprehensive information on military family members in
DEERS. Some family members are not eligible to receive military benefits. As a result, DoD
may not be able to retrieve all suicide death records on military family members, and suicide
counts and rates presented in this report may be underestimated for this population.
Definition of Military Family Member
Section 1072 (2) of the Title 10 U.S. Code defines a military family member with respect to a
member (or former) member of a uniformed Service, as:
1. A spouse;
2. Unremarried widow or widower;
3. Child who is:
a. Unmarried and under the age of 21; or
b. Physically or mentally incapable of self-support (regardless of age); or
c. Enrolled in full-time course of study at an institution of higher learning; dependent on
the member for over one-half of their support; and under the age of 23; 28
4. Unremarried former spouse of a current or former Service member; 29
5. Unmarried person who is placed in the legal custody of the Service member as a result of a
court order (e.g., a sibling);29 and
6. A parent or parent-in-law who is dependent on the Service member for over one-half of
his/her support and residing in his/her household.
For the purpose of the current report, military family members are limited to spouses and
dependent children (minor and non-minor), who are eligible to receive military benefits under
Title 10 and registered in DEERS. 30,31 For simplicity, dependent children are hereafter referred
to as “dependents” throughout the report.
CY 2017 Family Member Data Summary
The section below summarizes suicide counts and annual rates for military spouses and
dependents (defined in Title 10, U.S. Code) for CY 2017 (Table 4). 32 Data for CY 2018 were
unavailable for this report due to the time lag inherent in the collection of civilian death data. 33
In this report, family members could also be active Service members, as section 1072(2) of Title
10 does not explicitly exclude Service members from the definition of a dependent. 34 Inclusion
28

Dependents includes biological, step-, foster, ward, preadoptive, and domestic partner children.
Additional criteria may apply (see section 1072(2) of Title 10, U.S. Code).
30
DoD is unable to capture information on military family members unless they have received benefits; and thus, are registered in DEERS.
31
Other types of family members (e.g., parents, siblings, former spouses) who meet the specifications of Title 10 are not as reliably captured in
DEERS, as they must be registered by the Service member. As a result, DoD cannot reliably track the deaths by suicide among these individuals.
32
Note that, while not included in Table 4 counts for the military, per NDAA FY15, DoD collects data on suicide deaths for family members of
the U.S Coast Guard (USCG). In CY 2017, there were 3 USCG military family deaths.
33
It can take between 12 to 18 months for the CDC to receive death information from the state vital statistics offices. As a result, there is a 2-year
lag between the most recent available death information and any related report on military family member suicides.
34
Additionally, dual Service members can receive some family member benefits (e.g., FSGLI), which requires that they be registered in DEERS.
29

17

 of dual Service members in family member suicide counts and rate estimation allows the
Department to better capture the full extent of suicide among military family members.
Table 4. Family Member Suicide Rates per 100,000 by Component, CY 20171-3
Dependent
Spouse
Total
Count
Rate
Count
Rate
Count
Rate
Active Component
-2.9
-13.2
122
7.0
Reserve
---11.7
29
6.2
National Guard
-6.9
--35
6.5
Total Force
63
3.8
123
11.5
186
6.8
1.
2.
3.

Source(s): DEERS, Military Services, and NDI (suicide counts); DMDC (denominators).
Per DoDI 6490.16, rates for subgroups with fewer than 20 suicides are not reported due to statistical instability.
Per CDC requirements, counts under 10 were suppressed in order to protect the confidentiality of military family members.
Additional cells were also suppressed to ensure low counts could not be recreated.

CY 2017 Suicide Counts
There were 186 reported suicide deaths among military spouses and dependents in CY 2017
(Table 4). One hundred and twenty-three (n=123) suicide decedents were military spouses and
63 decedents were military dependents. The majority of military spouses who died by suicide
were female (69%) and under 40 years of age (82%), consistent with demographics of the overall
military spouse population. The majority of military dependents who died by suicide were male
(70%). While the ages ranged from 12-23 years old, almost 50% of dependent deaths were
among dependents who were 18 years old or older. Of those younger than 18 years old, the
majority of deaths occurred between the ages of 15 and 17 (62%).
CY 2017 Suicide Rates for Military Families and Comparisons to the U.S. General Population
The suicide rate among family members, all Services and Components combined, was 6.8 per
100,000 military family members (Table 4). This rate was lower than the U.S. general
population (14.5 per 100,000 individuals) for the same year. 35 This difference was not
surprising, as the sex and age composition differs between the two populations. 36 The family
member suicide rates were similar for the Active Component, Reserve, and National Guard,
ranging from 6.2 to 7.0 deaths per 100,000 individuals.
Suicide Rates by Sex for Military Family Members
Suicide rates by sex and family member type (spouse or dependent) are presented in Table 5. 37
The suicide rate for military spouses was 11.5 deaths per 100,000 in the population. When
examined by sex, suicide rates for female and male spouses, ages 18 to 60, were 9.1 and 29.4 per
100,000 populations, respectively. These rates were comparable to similar age (18 to 60 years of
age) female and male rates in the U.S. population (8.4 and 28.4 per 100,000, respectively).

35

Age ranges for suicide rates included dependents 0-23 years old and spouses 18-60 years old.
Compared to the U.S. population, military spouses are younger and more likely to be female and military dependents are younger.
37
Per DoDI 6490.16, age-specific rates were not presented as the number of suicide counts were less than 20 for each age grouping.
36

18

 Table 5. Military Family Suicide Rates per 100,000 Individuals by Sex, CY 20171-3

Active Component
Reserve
National Guard
Total Force
1.
2.
3.

Dependent
Male
Female
3.8
-----5.2
--

Spouse
Male Female
30.8
10.8
----29.4
9.1

Total
Male Female
7.3
6.8
--11.7
-8.4
5.9

Source(s): DEERS, Military Services, and NDI (suicide counts); DMDC (denominators).
Per DoDI 6490.16, rates are not reported when suicide counts are less than 20 due to statistical instability.
To facilitate comparisons with the U.S. general population, 95% confidence intervals for the rates were calculated.

The overall suicide rate for military dependents (both males and females) was 3.8 per 100,000
population. The suicide rate for male military dependents (5.2 per 100,000 population) was
lower than the rate among similar-age (< 23 years) males in the U.S. population (9.3 per 100,000
population). This finding was somewhat expected, as dependents of active Service members are
younger on average than dependents in the U.S. general population. 38 Per DoD policy, the
suicide rate for female military dependents was not reported (i.e., counts were under 20 for this
group).
Method of Family Member Suicide Death and Comparisons to the U.S. General Population
For both military spouses and dependents, firearm was the most common method of suicide
death (with the exception of dependents of National Guard members, with the most common
method of hanging/asphyxiation at 50.0% of those who died by suicide). The proportion of
suicide deaths by firearm ranged from 52.2% to 63.6% for spouses and 45.8% to 77.8% for
dependents, depending on Component (i.e., Active Component, Reserve, or National Guard).
The second leading method of death of those who died by suicide was hanging/asphyxiation for
most Components (ranging between 18.2% to 20.0% for spouses and 22.2% to 50.0% for
dependents). Overall, across all Components and military family members, 52.7% of suicide
deaths were by firearm and 26.3% were by hanging/asphyxiation. Firearm remained the leading
method of suicide death when examined by sex, even for female spouses (49.4%). This finding
appears to deviate from the U.S. general population, in which the leading methods of suicide for
females in CY 2017 were poisoning/drug overdose (31.4%) and firearm (31.2%), closely
followed by hanging/asphyxiation (27.9%).

Current and Future Departmental Efforts
Current Suicide Prevention Strategy, Governance, and Efforts
The Department recognizes that every life lost to suicide is a tragedy and remains committed to
the priority of prevention. The DoD embraces a public health approach to suicide prevention
that acknowledges a complex interplay of individual-, relationship-, and community-level risk
factors. This approach focuses on reducing suicide risk of all Service members and their family
38
Suicide rates are low for dependents under age 15 (i.e., 1.7 and 3.3 per 100,000 for females and males between the ages of 10 and 14 years in
CY 2017; CDC, 2018).

19

 members by attempting to address the myriad of underlying risk factors and socio-demographic
factors (e.g., reluctance towards help-seeking, relationship problems, financial difficulties, and
access to lethal means), while also enhancing protective factors (e.g., strong social connections,
problem-solving and coping skills).
The Department’s suicide prevention efforts are guided by the Defense Strategy for Suicide
Prevention (DSSP), which was signed in December 2015. The DSSP created the foundation and
alignment of efforts to focus on prevention activities using a public health approach, which
provides the greatest potential to prevent suicide. When developing the DSSP, the Department
worked with experts in the field and aligned the strategy to the National Strategy for Suicide
Prevention (NSSP), as published in 2012 by the Department of Health and Human Services,
Office of the U.S. Surgeon General. The DSSP uses the public health framework laid out in the
NSSP, and includes both community-based prevention efforts and medical care and treatment in
order to address suicidal thoughts and risk behaviors.
The Department’s suicide prevention efforts are led by a suicide prevention governance
body, comprised of senior executive leaders and general officers from the Military
Departments, Office of Force Resiliency, Office of the Assistant Secretary of Defense for
Health Affairs, Office of the Assistant Secretary of Defense for Manpower and Reserve
Affairs, Joint Staff, National Guard Bureau, and the U.S. Coast Guard. This Suicide
Prevention General Officer Steering Committee (SPGOSC) addresses present and future
suicide prevention needs, employing data-driven, evidence-informed practices that are
aligned with the DSSP and have DoD-wide applicability. In addition, a complementary
enterprise-wide, action-officer level committee—the Suicide Prevention and Risk Reduction
Committee (SPARRC)—is responsible for coordinated implementation of the guidance
provided by the SPGOSC. The SPARRC also provides an opportunity for collaboration,
communication, and documentation of suicide prevention promising practices across the
DoD.
In 2017, the CDC released a bundled public health approach as a technical package,
employing seven broad, evidence-informed strategies to focus on suicide prevention
activities that have been found to effectively impact risk and protective factors surrounding
suicide (Stone et al., 2017). These public health strategies to prevent suicide, support the
goals of the 2015 DSSP, and include:
1. Strengthening economic supports
2. Strengthening access and delivery of suicide care
3. Creating protective environments
4. Promoting connectedness
5. Teaching coping and problem-solving skills
6. Identifying and supporting people at risk
7. Lessening harms and preventing future risk
20

 Highlighted below are 15 selected Departmental suicide prevention initiatives that align to the
aforementioned CDC strategies. These examples are by no means an exhaustive list. These
initiatives address some of the key findings in this report, as well as data collected by the
DoDSER and other sources. These initiatives represent examples of suicide prevention efforts
across the Department. Unless otherwise indicated, the highlighted initiatives reflect new
evidence-informed efforts that are currently being piloted, or that will be piloted over the next
CY. Based on the effectiveness of these pilots, these new initiatives may be implemented more
broadly across the Department. The highlighted initiatives are listed below according to the
seven broad, evidence-informed strategies, with their linkage to one or more overarching goals
within the DSSP also delineated.
Strengthening Economic Supports
DSSP Goal 3: Educate military community on the protective factors against suicide that
also promote resilience and recovery in the Department of Defense.
DSSP Goal 5: Develop, implement, and monitor effective Department of Defense
programs that promote resilience, and prevent suicide and related behaviors.
As mentioned earlier in this report, research studies on military and civilian suicides and related
behaviors indicate that for some individuals, financial stress can increase overall stress, and can
represent an environmental risk for suicide (Turunen & Hiilamo, 2014; Ursano, Fullerton, &
Dichtel, 2016). Financial difficulties, including excessive debt and bankruptcy, were present in
the 90 days prior to death in 7.4 percent of CY 2017 active duty suicides (Pruitt, Smolenski,
Tucker, et al., 2019). Nevertheless, it is important to note that financial stress rarely operates to
increase suicide without a constellation of other biological, interpersonal, and psychological risk
factors of suicide (LeardMann et al., 2012). Below are on-going Departmental efforts focused
on strengthening the financial well-being of Service members and their families, while
decreasing this environmental risk for suicide.
Service Member and Family Financial Resources: On-Going Efforts
The Office of Financial Readiness and the Military Services provides programs, resources, and
professional support to help Service members achieve financial readiness, maintain skills to
make informed financial decisions, and meet personal and professional goals throughout the
military lifecycle. Financial literacy training is offered to prepare members and their families to
respond to the financial circumstances of personal and professional events, whether those are the
financial implications of getting married, managing finances during deployment, or conducting a
permanent change of station. In addition to traditional classroom or computer-based training, the
DoD is developing innovative learning approaches to meet the needs of members. These include
short, video "microlearning" modules intended to provide brief, accessible information on
financial considerations at each military lifecycle touchpoint, as well as on specific financial
topics associated with each touchpoint (such as understanding the military leave and earnings
statement during initial training).
21

 One-on-one financial counseling is offered to Service members and their families through a
number of resources. The Military Services employ approximately 400 Personal Financial
Managers (PFMs) at military installations worldwide. These nationally-accredited professionals
provide unbiased financial counseling and classroom education. The DoD also deploys a
flexible, contracted network of more than 315 nationally-accredited Personal Financial
Counselors (PFCs) to supplement PFMs at military installations. PFCs also provide support to
short, on-demand needs of the Reserve and National Guard, such as drill weekends, annual
training, family events, or deployment preparations. In addition, some Military Services train
select non-commissioned officers (NCOs) to provide front-line financial readiness support to
fellow members as a collateral duty to their typical responsibilities. These Command Financial
NCOs and Command Financial Specialists can provide basic financial management assistance
and serve as an advocate within their unit to promote the importance of financial readiness.
Service members and their families also have access to free, confidential financial counseling via
Military OneSource—a 24/7 call center and website. Accredited financial counselors provide
telephonic, video, and in-person financial counseling at many locations. Military OneSource
provides a valuable resource for members and families to access personal support at any time.
Strengthening Access and Delivery of Suicide Care

DSSP Goal 8: Promote suicide prevention as a core component of Military Healthcare
Services.
DSSP Goal 9: Promote and implement effective clinical and professional practices in
the Military Healthcare Services for assessing and treating those identified as being at
risk for suicidal behaviors.
Findings from this report, as well as prior DoDSER Annual Reports, indicate that the majority of
Service members who die by suicide are enlisted, less than 30 years of age, male, and white,
regardless of Component (Pruitt, Smolenski, Tucker, et al., 2019). It is important to note that
this group is a large cross-section of the military population and that having these demographic
characteristics, alone, does not put one at risk for suicide. Given the size of this cross-section, it
is important for the Department to develop universal approaches that tie suicide prevention to the
unique characteristics of military life and culture. Among Service members who experienced
significant distress, the greatest barrier to receiving care is stigma—the perception of being seen
as weak or of being treated differently by leadership (Sharp et al., 2015). In response, the
following example pilot initiatives have been launched to reduce stigma and strengthen access
and delivery of suicide care.
Zero Suicide Pilot
The Zero Suicide framework is a system-wide, organizational commitment to safer suicide care
in health and behavioral health care systems. The foundational belief of the Zero Suicide
program is that suicide deaths for individuals receiving care within health and behavioral health
22

 systems can be prevented. According to the CY 2017 DoDSER Annual Report, 51.5% of
Service members who died by suicide received some form of care (though not necessarily
suicide- or behavioral health-related care) via the Military Health Service (MHS) in the 90 days
prior to death. Although it is not known whether these individuals were suicidal at the time of
contact, these contacts could represent opportunities for identification and treatment of suicidal
risk. The Department funded a pilot study with the Air Force to train medical personnel at five
Air Force Military Treatment Facilities (MTFs) on suicide risk assessment, safety planning,
means safety education, and assessment of the effectiveness of suicide-related outcomes. The
results of the pilot (expected in late CY 2019) will inform the decision to potentially pilot or
begin implementing the Zero Suicide Framework more broadly in the DoD.
Resources Exist and Can Help (REACH) Training Pilot
REACH is a barrier reduction training intervention designed to address the most prevalent helpseeking concerns of Service members (e.g., career and security clearance loss concerns, loss of
privacy/confidentiality, and preference for self-management), and encourage Service members to
seek out help early on, before life challenges become overwhelming. Through the training,
Service members will become more familiar with help-seeking resources by observing a call to
Military OneSource, identifying different resources, and addressing perceptions of seeking care.
The REACH intervention is currently in development and is expected to begin piloting at
participating sites in CY 2020.
National Guard Bureau and VA Mobile Vet Center Initiative
The National Guard Bureau (NGB) and the Department of Veterans Affairs (VA) have a shared
goal to provide services to geographically dispersed Service members, Veterans, and their
families. VA mobile teams support outreach and support services (e.g., socioeconomic,
financial, coping, and life skills readjustment counseling, referral, and care coordination) during
drill weekends to improve National Guard force readiness and transition adjustment, and to
reduce suicides and other negative behaviors. This strategy provides an opportunity for early
identification, readjustment counseling, and referral support to members of the National Guard in
a systematic and centralized manner during drill weekends. It includes facilitating services to
National Guard members who are not eligible for other VA services. The initiative began in CY
2019.

23

 Creating Protective Environments

DSSP Goal 2: Implement research-informed communication efforts within the
Department of Defense that prevent suicide by changing knowledge, attitudes, and
behaviors.
DSSP Goal 6: Promote efforts within the Department of Defense to reduce access to
lethal means of suicide among individuals with identified suicide risk.
DSSP Goal 7: Provide military community service providers and military healthcare
service providers evidence-based training on the prevention of suicide and related
behaviors.
The Department regards the safety of our military families and dependents as highly as the safety
of our military members. The military is only as strong as those who are supporting them day-in
and day-out. As such, understanding and mitigating the risk factors for suicide in our military
families is a top priority. This report indicates that the primary method of suicide death for
Service members, military spouses, and their dependents was by firearm. Multiple research
studies in the civilian population have shown the presence of a household firearm to be
associated with an increased risk of suicide among adults and adolescents (Grossman et al.,
2005). The risk of unintentional and self-inflicted firearm injury is lower when all household
firearms are stored locked (Monuteaux et al., 2019).
Research has also shown that sometimes it only takes five to ten minutes for a suicidal individual
to go from thinking about suicide to acting on it (Nock et al., 2018). When lethal means are
made less available or less deadly, suicide rates have been shown to decrease in both U.S. and
international populations (Anestis & Anestis, 2015). Delaying the time between the thought and
action by decreasing access to lethal means can help prevent suicide, because it allows more time
for intervention (Deisenhammer et al., 2009; Simon et al., 2001; U.S. Department of Health and
Human Services, 2012). Means safety interventions have been shown to decrease suicide rates;
in fact, such interventions have demonstrated more potential for reducing suicides than clinical
interventions (Zalsman et al., 2016). Below are examples of two new initiatives focused on
means safety for Service members and their families.
Counseling on Access to Lethal Means Training Pilot
Counseling on Access to Lethal Means (CALM) is a training designed to help civilian mental
health professionals implement counseling strategies to reduce access to lethal means and help
promote safe use and storage of firearms for individuals at risk for suicide. The Department is
piloting the CALM training for non-medical military providers, such as Military and Family Life
Counselors and Military OneSource triage consultants. Initial training for the providers began in
CY 2019 and CALM will be expanded to chaplains and community counselors in installationbased Personnel and Family Support Centers in CY 2020. This pilot will include representation
from all Military Services.
24

 Social Norms for Safe Firearm Storage
Safe firearm storage is described as consistently securing a firearm with a gun lock or gun safe,
separate from ammunition, when not in use. There are four factors that protect firearm-owning
homes from suicides: 1) using gun locks, 2) keeping firearms unloaded, 3) storing ammunition
separate from firearms, and 4) storing firearms away from the home (Grossman et al., 2005).
Public health messaging on safe firearm storage is needed in order to promote firearm safety
practices as an acceptable norm and decrease risk. The Department will implement a
collaborative communications campaign to promote social norms for safe storage. Like other
public health campaigns focused on reducing smoking, reducing drunk driving, and increasing
breast cancer screening, safe firearm storage messaging will have a clear goal and an easy-toremember slogan for greater reach to Service members and their families. The messages are
currently in development and are expected to be disseminated in CY 2020 across all Services.
Promoting Connectedness

DSSP Goal 2: Implement research-informed communication efforts within the
Department of Defense that prevent suicide by changing knowledge, skills, and
behaviors.
DSSP Goal 3: Educate military community on the protective factors against suicide that
also promote resilience and recovery in the Department of Defense.
DSSP Goal 5: Develop, implement, and monitor effective Department of Defense
programs that promote resilience, and prevent suicide and related behaviors.
As mentioned earlier in this report, relationship stressors, such as failed or failing intimate
partner relationships, are frequently cited risk factors for suicide. For example, failed or failing
relationships in the 90 days prior to death were reported in 36.9% of active duty suicides in CY
2017 (Pruitt, Smolenski, Tucker, et al., 2019). Research suggests strong social connections
protect against suicide, along with undeniably enhancing the quality of one’s life (CDC, 2008;
Straus et al., 2019). By facilitating access to additional peer support by phone or web, or
implementing active contacts from health professionals after a crisis, promoting connectedness
can have far reaching, positive effects on the entire population. The following on-going efforts
complement the existing military organizational structure and support by enhancing
connectedness during times of stress or transition.
Peer-to-Peer Support: On-Going Effort
The Department provides access to peer-to-peer support through Military OneSource, the
Department’s 24/7 call center and website that provides comprehensive information, resources,
and assistance on every aspect of military life at no cost to the user. Service members and
military spouses can contact Military OneSource to schedule an appointment with consultants
who are Veterans, members of the National Guard or Reserve, or military spouses and can relate
to callers through their shared experience.
25

 Non-Medical Counseling: On-Going Effort
The Department provides access to non-medical counselors through the Military and Family Life
Counseling and Military OneSource programs at no cost to Service members and their
families. Counselors possess a master's or doctorate degree in a mental health field and are
licensed or certified in a state, territory, or the District of Columbia to practice
independently. Military and Family Life Counselors provide services, face-to-face, on and near
military installations. Military OneSource offers non-medical counseling face-to-face, by phone,
secure online chat, and video through a network of counselors in the local community. Nonmedical counseling can address issues such as relationship and parenting skills, stress
management, and coping with loss and grief. If issues need more intensive care, non-medical
counselors will refer individuals to military treatment facilities, TRICARE, or other helping
resources as appropriate. Service members and military spouses can contact Military OneSource
to locate and schedule an appointment with a non-medical counselor.
Teaching Coping and Problem-Solving Skills
DSSP Goal 2: Implement research-informed communication efforts within the
Department of Defense that prevent suicide by changing knowledge, attitudes, and
behaviors.
DSSP Goal 3: Educate military community on the protective factors against suicide that
also promote resilience and recovery in the Department of Defense.
DSSP Goal 5: Develop, implement, and monitor effective Department of Defense
programs that promote resilience, and prevent suicide and related behaviors.

This report emphasizes the need to target efforts towards the military’s youngest population.
Emerging research indicates that some Service members have stressful life events that they are
unable to “adjust” to or cope with and may exacerbate their vulnerability to suicide (Bachynski
et al., 2012; Wilks et al., 2019). For example, administrative or legal difficulties (e.g., article 15,
administrative separations, medical evaluation board proceedings, civil legal proceedings) in the
90 days prior to death were reported for approximately 30% of active duty Service members who
died by suicide in CY 2017 (Pruitt, Smolenski, Tucker, et al., 2019). Addressing coping and
problem-solving, particularly among young, new Service members at this formative stage in life,
may normalize how Service members address stress, seek help when needed, and solve problems
without violence or self-harm. Below is an example of a new initiative focused on teaching such
coping and problem-solving skills, which the Department can target to our youngest population
with the intention of teaching enduring skills that can help change culture around how to handle
inevitable life stressors.

26

 Rational Thinking–Emotion Regulation–Problem-Solving Training Pilot
The Department, in collaboration with Uniformed Services University of the Health Sciences
(USUHS), is developing an interactive, evidence-informed educational program to be delivered
early in the military career to improve new Service members’ short- and long-term functioning in
the areas of rational-thinking, emotion regulation, and problem-solving. The Rational ThinkingEmotion Regulation-Problem-Solving (REPS) training is designed as a suicide prevention
strategy to reduce overall risk for suicidal behaviors over time among Service members and to
address Service members’ preference for self-management. The pilot began in CY 2019, and is
being implemented at the Navy “A” school, the first stop after basic training. This environment
provides a unique window of opportunity to foster adaptive and strategic skills among young
Service members. By offering REPS, the Department aims to integrate suicide prevention into
the values, culture, leadership, and work of new Service members and their instructors.
Identifying and Supporting People at Risk

DSSP Goal 1: Integrate and coordinate suicide prevention activities across the
Department of Defense.
DSSP Goal 2: Implement research-informed communication efforts within the
Department of Defense that prevent suicide by changing knowledge, attitudes, and
behaviors.
DSSP Goal 3: Educate military community on the protective factors against suicide that
also promote resilience and recovery in the Department of Defense.
DSSP Goal 5: Develop, implement, and monitor effective Department of Defense
programs that promote resilience, and prevent suicide and related behaviors.
The military is built on a culture of connection among Service members. Service members train
to learn the importance of the team and taking care of the Service member to their left and right.
Recognizing the important role of the unit and community, the Department has on-going efforts
focused on peer and leader interventions, as well as new pilot initiatives underway.
Service Member Gatekeeper and Leadership Interventions: On-Going Effort
Recognizing the important role of an individual’s immediate network to detect warning signs or
concerning changes in behavior, each military Service has modified and implemented the
Question, Persuade, Refer (QPR) framework as part of its suicide prevention training program to
empower Service members to act as “gatekeepers.” 39 The Service variations on the QPR
framework (Examples: Army: Ask, Care, Escort (ACE); Navy: Ask, Care, Treat (ACT); Marine
Corps: Recognize, Ask, Care, Escort (RACE)) are based on their Service culture and needs. All
39
The Suicide Prevention Resource Center (SPRC) designated this as a “program with evidence of effectiveness” based on its inclusion in
SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP). Information about the QPR Gatekeeper Training for
Suicide Prevention is available on SPRC website: https://www.sprc.org/resources-programs/qpr-gatekeeper-training-suicide-prevention

27

 Services emphasize the importance of teaching Service members and gatekeepers to recognize
the warning signs of suicide, react in a non-judgmental way, ask the Service member in trouble if
he or she is suicidal, and refer the Service member to a helping professional trained in suicide
crisis intervention.
Recognizing the Signs of Intent to Die by Suicide on Social Media Training Pilot
Use of social networking sites comprise the single most popular online activity, with more than
3.4 billion active social media users worldwide spending 27 percent of every year, or over 6
hours a day, of their time. 40 Additionally, 88% of American 18-29 year olds use social media
(Pew Research Center, 2019). To reach the online community, specifically young Service
members that may see different aspects of an individual’s life, the Department has recently
developed a training video about social media indications that may precede suicide ideation and
behavior. The training video will educate individuals about the emergence of warning signs of
suicide on social media, as well as the constructive steps to take to intervene in a crisis and refer
to appropriate care, including an understanding of why individuals should or should not take
specific actions. A Department-funded study that identified patterns of social and behavioral
risks on social media platforms preceding suicide provides the research base for this training
(Bryan et al., 2018). The pilot and evaluation of the training video will be completed in CY
2020.
Cognitive Behavior Strategies for the Prevention of Suicide Training Pilot
This pilot will develop and evaluate a manual-based training program to teach military chaplains
cognitive behavioral strategies aimed at reducing suicide risk. The project will enhance existing
suicide prevention efforts by systematically producing an evidence-informed cognitive
behavioral suicide prevention guide that is culturally adapted for use by military chaplains and
assistants. The findings will inform the Department about ways in which to maximize the role of
chaplains as gatekeepers, trainers, and individuals ready and capable to assist effectively and
competently with Service members at risk for suicide. The training pilot began in CY 2019 and
is currently being adapted for online use.
Suicide Prevention and Readiness for the National Guard (SPRING)
The SPRING project, started in 2019, provides core programmatic and analytics support for the
Warrior Resilience and Fitness Program. Advanced analytics are used to examine protective
factors, risks, and promising practices related to suicide and readiness in the National Guard.
SPRING utilizes the Total Force Fitness (TFF) framework and readiness model to inform a datadriven and holistic approach for data collection and analysis. A systematic approach is also used
to gather evidence-informed and programmatic data, which are assessed to identify gaps and
important areas of need. Finally, the project applies advanced analytics to develop tools that
further analyze data to inform solutions, working towards the optimization of resources and
initiatives that enhance psychological fitness and improve readiness in the National Guard.

40

Digital Report 2019. https://datareportal.com/library

28

 Lessening Harms and Preventing Future Risk
DSSP Goal 4: Encourage responsible media reporting and portrayals of military
community suicide and mental illnesses and promote the accuracy and safety of online
content related to suicides in the Department.
DSSP Goal 10: Provide support and quality services for those in the military community
affected by suicide deaths and attempts and implement community-wide postvention
strategies to help prevent subsequent suicides.
Recent research has indicated that about 135 people may be exposed to one death by suicide
(Cerel et al., 2019). Over and above the impact of bereavement by other causes, exposure to
suicide of a relative or friend increases the risk for depression, death by suicide, and/or hospital
admissions (Cerel et al., 2016; Harrington-LaMorie, Jordan, Ruocco, & Cerel, 2018; Pitman,
Osborn, King, & Erlangsen, 2014). Hence, it is important to have an effective response to the
death by suicide that encompasses the entire community to prevent further harm. Suicide
postvention is described in the literature as a combination of services designed to reduce the
distress and impact of suicide death among survivors of the loss (Aguirre & Slater, 2010).
Additionally, media reporting on suicide can have an impact on suicide contagion (Ferguson,
2018). The Department has several efforts underway to lessen these potential harms and prevent
future risk.
Suicide Postvention Toolkit
The Department is developing a comprehensive, evidence-informed resource guide for DoD
postvention providers (e.g., commanding officers, chaplains, casualty assistance officers, Suicide
Prevention Program Managers, military first responders, mental health professionals) regarding
best practices for delivery of bereavement and postvention services to unit members and next of
kin who survive a military suicide loss. This postvention guide was created based on findings
from a Department-funded research study (Ho et al., 2018) and inputs of key internal and
external Departmental stakeholders, including the Tragedy Assistance Program for Survivors.
This toolkit is slated to be completed in CY 2019.
Safe Messaging and Reporting on Military Suicide
Media reporting of suicide can lead to imitating suicide-related behavior (Stack, 2000). Media
portrayals of DoD suicide events may influence suicide behavior, stigma, and perceptions of
suicide among members of the military. The World Health Organization (WHO), in partnership
with the International Association for Suicide Prevention (IASP), released a resource for media
professionals about how to report on suicide (2008). The aim of this DoD safe messaging and
reporting project, which began in CY 2019, is to determine how well the WHO guidelines are
followed for media reporting of DoD suicide events. This project will inform the Department on
any necessary training, education, or engagements needed with DoD Public Affairs Officers,
military senior leaders, and/or media sources. Increases in responsible reporting can educate the
29

 military community and the public about suicide and encourage those at risk of suicide to seek
help.
Evaluating Programs and Assessing Effectiveness
Based on the goals and objectives of the DSSP, and specific guidance provided by the
SPGOSC, the Department is focused on fully implementing and evaluating a multi-faceted
public health approach to suicide prevention. The Department has already implemented a
number of suicide prevention policies, initiatives, and resources. Further, as scientific
research surrounding the prevention of suicide is both complex and ever-evolving, the
Department has also recently launched several evidence-informed pilots aligned with the
DSSP and the aforementioned seven broad, evidence-informed strategies (as described
earlier in this section). This work directly contributes to the accomplishment of DSSP Goals
11, 12, and 13 (below).

DSSP Goal 11: Improve the timeliness and usefulness of Department of Defense
surveillance systems relevant to suicide prevention, and improve the ability to collect,
analyze, and use this information for improving Department suicide prevention efforts.
DSSP Goal 12: Promote and support Department of Defense research on suicide
prevention.
DSSP Goal 13: Evaluate the impact and effectiveness of Department of Defense suicide
prevention interventions and systems in order to synthesize and disseminate the findings.
To evaluate the effectiveness of the Department’s non-clinical suicide prevention initiatives,
including both current efforts and new pilot initiatives, the Department, in collaboration with
the Military Services, developed a program evaluation framework that maps the goals,
objectives, and initiatives articulated in the DSSP to measurable outcomes, employing two
types of outcomes to measure progress and effectiveness. The first set are distal outcomes, to
include reduction in suicide deaths and attempts. Reductions in these behaviors constitute
the ultimate indicators for success; however, achieving a reduction in these behaviors
requires a coordinated implementation of multiple suicide prevention initiatives and activities
over a long period of time. For a more immediate understanding of the effectiveness of nonclinical suicide prevention initiatives, the Department also developed proximal outcomes,
such as improving safe communication and reporting practices about suicide, increasing
help-seeking behaviors, and reducing perceived barriers to care. These proximal outcomes
address the different risk factors (e.g., individual and environmental factors that make suicide
more likely to occur) and protective factors (e.g., individual and environmental factors that
buffer the risk for suicide). Positive changes in proximal outcomes are expected to lead to
decreases in distal outcomes, which is the reduction of suicide deaths and attempts. The
Department will leverage the data from this report and will continuously monitor suicide data
of Service members and their family members and evaluate the effectiveness of on-going
30

 efforts and new pilot initiatives in combatting suicide in the DoD. Baseline data on
Departmental non-clinical suicide prevention evaluation efforts are expected in CY 2020.
Conclusion
The Department is strongly committed to preventing suicides among Service members and their
families. Suicide is the culmination of complex interactions among biological, social, and
psychological factors operating at individual, community, and societal levels. As a Department,
we have made strides in establishing an infrastructure for preventing military suicide by: aligning
our strategy with the public health approach; establishing policy guidance and an enterprise-wide
governance body; standardizing and advancing data surveillance, research, clinical interventions,
and program evaluation; and partnering and engaging with other federal, non-profit, and private
organizations. We have more work to do, and much more progress to make.
This first-ever ASR is reflective of the Department’s efforts to increase transparency and
frequency of reporting with respect to military suicides. This increased transparency and
accountability will strengthen our program oversight and policies. This ASR also marks the first
time the Department has reported on military family member suicides. The Department will
continue to work to effectively capture military family suicide deaths and report these data in a
transparent and timely manner, reporting on these data each year. Once data has been gathered
for a sufficient number of years to enable trend identification, the Department will target efforts
to identifying key trends for our military family members.
The DoD is deeply committed to ensuring the health, safety, and well-being of our Service
members and their families. The Department recognizes the importance of educating both our
Service members and their families on suicide risk factors, as well as on ways to promote healthy
environments and wellness, and reduce the overall risk factors for suicide, such as relationship
issues and periods of transition. The Department is also focused on reducing barriers to care and
the associated perceived stigma, and increasing help-seeking, among our military community.
Moving forward, the Department will continue to fully implement and evaluate a comprehensive,
multi-faceted public health approach to suicide prevention, as well as pilot new evidenceinformed practices gathered from the ever-evolving science on suicide prevention, to prevent
suicides among our Service members and military families.

31

 Appendix A: Suicide Rates CY 2011-2018
Suicide Mortality Rates Over Time
According to the Defense Health Agency (DHA) Psychological Health Center of Excellence
(PHCoE), the age- and sex-adjusted suicide mortality rates for the Active Component and
Reserve demonstrated statistically significant increases in the linear trend analysis from CY
2011-2018 (Figure A1). 41 The annual suicide mortality rates for the National Guard did not
show evidence of a linear increase from CY 2011-2018. These suicide mortality rates were
adjusted for age and sex.
Figure A1. Adjusted annual suicide mortality rates for the Active Component, Reserve, and
National Guard, CY 2011-20181-3

1.
2.
3.

41

Source(s): Graphics provided by PHCoE; data obtained from AFMES.
Note: CI = Confidence Interval. All rates are adjusted for age and sex.
The three-year moving average for each year with an estimate is the average of the rate for that CY, the previous CY, and the following CY.

Note that statistically significant trends may shift depending on the time frame selected for analysis.

32

 There were statistically significant linear increases in the age- and sex-adjusted suicide mortality
rates for the Active Component populations of the Air Force and the Marine Corps from CY
2011-2018. While the Army and the Navy showed increasing slopes for their rates, the changes
were not statistically significant over this timeframe. The changes over time in the annual
suicide mortality rates for the Active Component populations of the Army, Navy, Marine Corps,
and Air Force are displayed in Figure A2.
Figure A2. Adjusted annual suicide mortality rates for the Active Component, by Service, CY
2011-20181-3

1.
2.
3.

Source(s): Graphics provided by PHCoE; data obtained from AFMES.
Note: CI = Confidence Interval. All rates are adjusted for age and sex.
The three year moving average for each year with an estimate is the average of the rate for that CY, the previous CY, and the following CY.

33

 Comparison of Military and U.S. General Adult Population Standardized Rates
PHCOE also found that CY 2018 suicide mortality rates for the Active Component and Reserve
did not differ from the U.S. adult population suicide mortality rates for CY 2017 (Figure A3).
This means that the suicide rates for the Active Component and Reserve were consistent with
what would be expected given the age and sex composition of the military populations and the
age and sex-specific suicide mortality rates of the U.S. adult population. The National Guard had
a higher suicide mortality rate than expected from the U.S. adult population data (Figure A3).
Figure A3. CY 2011-2018 annual suicide mortality rates, by Component, standardized to the CY
2011-2017 U.S. adult population rate data.1-3

1.
2.
3.

Source(s): Graphics provided by PHCoE; data obtained from AFMES.
Note: the U.S. population data include data from civilians, as well as current and former military Service members.
For CY 2018, the U.S. population value is repeated from CY 2017, as CY 2017 was the most recent U.S. population data available at the
time of this publication.

34

 Appendix B: Common Suicide Misconceptions
MISCONCEPTION #1: The military suicide rate is higher than the U.S. general population.
FACTS: The Department is often asked to describe how suicide rates in the DoD compare to
those in the U.S. population. 42 In CY 2017, the suicide rate for the U.S. population, ages 17-59,
was 18.2 deaths per 100,000 individuals. 43 By comparison, the suicide rate in the military in
CY 2017 ranged from 21.9 in the Active Component to 29.8 in the National Guard. On the
surface, suicide in the military appears to be markedly higher than the U.S. population—the rate
is at least 48% higher depending on Component. Nevertheless, the direct comparison of military
suicide rates and the U.S. population is misleading. It is well established that males have nearly
four times higher risk of suicide death than females. 44 As the U.S. military is comprised of a
higher percentage of males (85%) compared to the U.S. population (49.2%), 45 it is not surprising
that the suicide rate is higher in the military. Age is another demographic factor that is
associated with suicide risk and also varies substantially between the military and U.S.
population. The U.S. military is made up of a higher percentage of younger individuals (mean
age = 28.5) than the U.S. population (mean age = 41.3). Given the differences in composition
between the U.S. military and general population, any comparison of suicide rates must first
account for age and sex. After controlling for differences in age and sex between these
populations, suicide rates are roughly equivalent for all Components, except the National
Guard (see Appendix A).
MISCONCEPTION #2: Deployment increases suicide risk among Service members.
FACTS: Several studies have shown that being deployed (including combat experience,
length of deployment, and number of deployments) is not associated with suicide risk
among Service members. 46,47 In addition, of active duty Service members who died by suicide
in CY 2017, 41.7% had no history of deployment (Pruitt, Smolenski, Tucker, et al., 2019).
However, there are some factors related to deployment that may affect suicide risk, such as being
repeatedly deployed with six months or less between deployments, or being deployed too soon

42
Suicide rates calculated for the U.S. population are often incorrectly cited as “civilian” rates. However, a true “civilian” rate is unable to be
accurately calculated at this time, in part, due to difficulties associated with U.S. state and local authorities correctly identifying the military status
of deceased individuals. As a result, CDC civilian rates include Service members and Veterans.
43
Pruitt, L. D., Smolenski, D. J., Bush, N. E., Skopp, N. A., Edwards-Stewart, A. & Hoyt, T.V. (2017). Department of Defense Suicide Event
Report (DoDSER): Calendar Year 2017 Annual Report.
https://www.pdhealth.mil/sites/default/files/images/docs/DoDSER_CY_2016_Annual_Report_For_Public_Release_508_2.pdf.
44
Centers for Disease Control and Prevention (CDC). Web-based Injury Statistics Query and Reporting System (WISQARS). Available from
http://www.cdc.gov/injury/wisqars/index.html. Most recent year data is available is 2017.
45
U.S. Census Bureau. 2010. Available at https://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf
46
LeardMann, C., Powell, T., Smith, T., Bell, M., Smith, B., Boyko, E., …Hoge, C. (2012). Risk factors associated with suicide in current and
former US military personnel. JAMA, 310(5), 496-506.
47
Reger, M. A., Tucker, R. P., Carter, S. P., & Ammerman, B. A. (2018). Military Deployments and Suicide: A Critical Examination.
Perspectives on Psychological Science, 13(6), 688–699. https://doi.org/10.1177/1745691618785366

35

 after joining the military. 48,49 It is important to note that suicide is complex and there is no single
cause for suicide among Service members or the general U.S. population.
MISCONCEPTION #3: The majority of Service members who die by suicide had a mental
illness.
FACTS: Approximately half (54%) of people who died by suicide in the U.S. 50 and 50.8% of
military suicide decedents did not have a mental health diagnosis. 51 Research in both the
military, as well as the U.S. population, has refuted the exclusive causal connection between
mental illness and suicide. While most people with mental health problems do not attempt or die
by suicide, the level of suicide risk associated with different types of mental illness varies. 52
There are other factors such as economic influences, cultural norms, access to lethal means, and
media reporting/messaging about suicide that impact suicide rates above and beyond mental
illness. 53
MISCONCEPTION #4: If you remove access to one lethal method of suicide, someone at risk
for suicide will replace it with another.
FACTS: A considerable amount of rigorous research has indicated that when lethal means are
made less available or less deadly, suicide rates by that method and rates overall decline. 54 This
has been demonstrated in a number of safety improvements: bridge barriers, detoxification of
domestic gas and pesticides, medication packaging, and others. Means safety interventions have
resulted in a decrease in suicide rates and have demonstrated more potential for reducing suicides
than clinical interventions. 55 Further, research has debunked the misconception that people
substitute methods of suicide. If access to the most lethal means of suicide is limited, other
means are not substituted. 56 ,57

48
Bryan, C. J., Griffith, J. E., Pace, B. T., Hinkson, K. , Bryan, A. O., Clemans, T. A. and Imel, Z. E. (2015), Combat Exposure and Risk for
Suicidal Thoughts and Behaviors Among Military Personnel and Veterans: A Systematic Review and Meta‐Analysis. Suicide Life Threatening
Behavior, 45: 633-649. doi:10.1111/sltb.12163
49
Ursano R.J., Kessler R.C., Naifeh J.A., et al. Associations of Time-Related Deployment Variables With Risk of Suicide Attempt Among
Soldiers: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). JAMA Psychiatry. 2018;75(6):596–
604. doi:10.1001/jamapsychiatry.2018.0296
50
Centers for Disease Control. (2018). Suicide rising across the US: More than a mental health concern. Retrieved from
https://www.cdc.gov/vitalsigns/suicide/index.html
51
Pruitt, L.D., Smolenski, D.J., Tucker, J., Issa, F., Chodacki, J., McGraw, K., & Kennedy, C.H. (2019). Department of Defense Suicide Event
Report (DoDSER): Calendar Year 2017 Annual Report.
52
Stone, D., Holland, K., Bartholow, B., Crosby, A., Davis, S., & Wilkins, N. (2017). Preventing suicide: A technical package of policies,
programs, and practices. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
53
Anestis, M., & Houtsma, C. (2017). The association between gun ownership and statewide overall suicide rates. Suicide and Life-Threatening
Behavior, 48(2), 204-217. https://doi.org/10.111/sltb.12346
54
Bowles, J. R., (1995). Suicide in Western Samoa: An example of a suicide prevention program in a developing country. In R.F.W. Diekstra, W.
Gulbinat, I. Kienhorst, & D. de Leo. (Eds.), Preventative strategies on suicide (173-206). Leiden (Netherlands): E. J. Brill.
55
Harvard T. H. Chan School of Public Health. (n.d.). Means Matter Website. http://www.hsph.harvard.edu/means-matter.
56
Owens, D., Horrocks, J., & House, A. (2002). Fatal and non-fatal repetition of self-harm: Systematic review. British Journal of Psychiatry,
18(3), 193-199. https://doi.org/10.1192/bjp.181.3.193
57
Barber, C.W., & Miller, M.J. (2014). Reducing a suicidal person’s access to lethal means of suicide: A research agenda. American Journal of
Preventive Medicine, 47(3), S264–S272.

36

 MISCONCEPTION #5: Talking about suicide will lead to and encourage suicide.
FACTS: Talking about suicide will not lead to suicide. 58 It does not give someone the idea
of suicide, nor does it encourage someone to act on those thoughts. There is a widespread stigma
associated with suicide, which may lead people to be afraid to speak about it. 59 Talking about
suicide not only reduces the stigma, but also allows individuals to seek help, rethink their
opinions, and share their story with others. Most people who attempt or die by suicide have
communicated their distress or plans to at least one person. 60 Talking about suicide with a person
gives them an opportunity to express thoughts and feelings about something they may have been
keeping secret, as well as obtain help and support as needed.58, 61

58

Dazzi, T., Gribble, R., Wessely, S., & Fear, N.T. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is
the evidence? Psychological Medicine, 44(16), 3361–3363. https://doi.org/10.1017/S0033291714001299
59
Tadros, G., & Jolley, D. (2001). The stigma of suicide. British Journal of Psychiatry, 179(2), 178-178. https://doi.org/10.1192/bjp.179.2.178
60
Ramchand, R., Franklin, E., Thornton, E., Deland, S., & Rouse, J. (2017). Opportunities to intervene? “Warning signs” for suicide in the days
before dying. Death Studies, 41(6), 368-375. https://doi.org/10.1080/07481187.2017.1284956
61
Anestis, M.D., & Green, B.A. (2015). The impact of varying levels of confidentiality on disclosure of suicidal thoughts in a sample of United
States National Guard personnel. Journal of Clinical Psychology, 71(10), 1023-30. https://doi.org/10.1002/jclp.22198

37

 Appendix C: Acronyms and Abbreviations
AFMES – Armed Forces Medical Examiner System
ASR – Annual Suicide Report
CDC – Centers for Disease Control and Prevention
CY – Calendar Year
DEERS – Defense Eligibility Enrollment Reporting System
DHA – Defense Health Agency
DMDC – Defense Manpower Data Center
DoD – Department of Defense
DoDI – Department of Defense Instruction
DoDSER – Department of Defense Suicide Event Report
DSPO – Defense Suicide Prevention Office
DSSP – Department of Defense Strategy for Suicide Prevention
FY – Fiscal Year
MTF – Military Treatment Facility
NDAA – National Defense Authorization Act
NDI – National Death Index
NGB – National Guard Bureau
NSSP – National Strategy for Suicide Prevention
PFC – Personal Financial Counselor
PFM – Personal Financial Manager
PHCoE – Psychological Health Center of Excellence
QPR – Question, Persuade, Refer
REACH – Resources Exist and Can Help
REPS – Rational Thinking –Emotion Regulation -Problem-Solving
SPARRC – Suicide Prevention and Risk Reduction Committee
SPGOSC – Suicide Prevention General Officer Steering Committee
SPRING – Suicide Prevention and Readiness for the National Guard
TFF – Total Force Fitness
USD (P&R) – Under Secretary of Defense for Personnel and Readiness
USUHS – Uniformed Services University of the Health Sciences
VA – The Department of Veterans Affairs
WISQARS – Web-Based Injury Statistics Query and Reporting System
38

 Appendix D: Terms and Definitions
Active Component: Per the Office of the Deputy Chief Management Officer, the Active
Component is, “the portion of the armed forces as identified in annual authorization acts as
‘active forces,’ and in section 115 of Title 10 USC as those active duty personnel paid from
funds appropriated for active duty personnel.”
Active Duty (AD): Full-time duty in the active military service of the United States. Such term
includes full-time training duty, annual training duty, and attendance, while in the active military
service, at a school designated as a service school by law or by the Secretary of the military
department concerned. Active duty is prescribed by Title 10 U.S. Code.
Armed Forces Medical Examiner System: The system within the Defense Health Agency that
provides worldwide comprehensive medico-legal services and investigations, as well as tracks all
deaths subject to its jurisdiction (active duty status deaths; see Active Duty), their determination,
and other relevant information.
Contagion: A phenomenon whereby susceptible persons are influenced toward suicidal
behavior through knowledge of another person’s suicidal acts. Closeness to an individual, group,
or individuals within a specific organization may increase the risk of contagion.
Death by Suicide: Synonymous with a manner of death classification of suicide.
Defense Eligibility Enrollment System (DEERS): A computerized database of military
sponsors (active duty, retired, or member of the Reserve Component) and their eligible family
members. DEERS registration is required for certain military benefits including TRICARE.
DoDSER Annual Report: This report is the Department’s official source for DoDSER suicide
and suicide attempt data (e.g., including medical and behavioral health factors, military-related
factors, psychosocial and lifestyle stressors). This report includes longitudinal suicide trends in
the DoD (beginning in 2011 to current year). It seeks to enhance the Department’s
understanding of suicidal behavior as well as further inform future research, program
development, and policy efforts.
Evidence-based: A conclusion based on rigorous research that has demonstrated effectiveness
in achieving the outcomes that it is designed to achieve.
Fiscal Year (FY): Begins October 1 and ends September 30 each year.
Gatekeeper: Can include anyone who is strategically positioned to recognize and refer someone
at risk of suicide (e.g., parents, friends, neighbors, teachers, coaches, caseworkers, police
officers) to care.
Intervention: A strategy or approach that is intended to prevent an outcome or alter the course
of an existing challenge or stress; also known as “secondary prevention.”

39

 Manner of Death: The legal classification of death. There are five manners of death: suicide,
homicide, accident, natural, and undetermined.
Means: How the injury was inflicted (i.e., how the person was hurt). The classification by
mechanism characterizes the external agents or particular activities that caused the injury (e.g.,
motor vehicle, firearm, submersion, fall, and poisoning).
Means Safety: Programs and policies aimed at making lethal means less available or safer and
thereby reducing the overall lethality of suicide attempts.
Mental Health: The capacity of individuals to interact with one another and the environment in
ways that promote subjective well-being, optimal development, and use of mental abilities
(cognitive, affective, and relational).
Mental Illness: A diagnosable illness characterized by alterations in thinking, mood, or
behavior (or some combination thereof) associated with distress that significantly interferes with
an individual’s cognitive, emotional, or social abilities.
Military Community: A broad term, equivalent to ‘the community’ in the 2012 National
Strategy for Suicide Prevention ecological model, designed to capture applicable members of the
Total Force and military family members, as well as to describe the general surroundings in
which they live and work (e.g., unit, base, station).
Military Family Members (or Military Dependents): Military Family Members (also known
as Military Dependents) are those who are sponsored by the Military Service member, are
enrolled in the Defense Eligibility Enrollment System (DEERS), and meet the requirement for a
military dependent as defined by Title 10 U.S. Code Section 1072 (2).
Military Treatment Facility (MTF): A military hospital or clinic on or near a military base.
National Death Index (NDI): The NDI is a centralized database of death record information on
file in state vital statistics offices. The CDC’s National Center for Health Statistics works with
state offices to establish the NDI as a resource to aid epidemiologists and other health and
medical investigators with their mortality ascertainment activities. In this report, the NDI was
used to supplement DoD data sources in the identification of family member suicides.
Postvention: Response activities that should be undertaken in the immediate aftermath of a
suicide that has impacted the unit and family. Postvention has two purposes: to help suicide
attempt survivors cope with their grief and to prevent additional suicides. It also may provide an
opportunity to disseminate accurate information about suicide, encourage help-seeking behavior,
and provide messages of resilience, hope, and healing. Also known as “tertiary prevention.”
Prevention: A strategy or approach that reduces the risk or delays the onset of adverse health
problems, or reduces the likelihood that an individual will engage in harmful behaviors. Also
known as “primary prevention.”

40

 Protective Factors: Skills, strengths, or resources that help people deal more effectively with
stressful events. Protective factors enhance resilience and help to counterbalance risk factors.
Protective factors may be personal (e.g., attitudes, values, and norms prohibiting suicide) or
external or environmental (e.g., strong relationships, particularly with family members).
Reserve Component: The Armed Forces of the United States Reserve Component consists of
the Army National Guard of the United States, Army Reserve, Navy Reserve, Marine Corps
Reserve, Air National Guard, Air Force Reserve, and the Coast Guard Reserve.
Resilience: The ability to withstand, recover, and grow in the face of stressors and changing
demands.
Risk Factors: Factors caused by stress, trauma, or other circumstances that cause a schism in
protective factors. Factors that make it more likely those individuals will develop a disorder or
pre-dispose one to high-risk for self-injurious behaviors. Risk factors may encompass biological,
psychological, or social factors in the individual, family, and environment.
Safety Plan: Written list of warning signs, coping responses, and support sources that an
individual may use to avert or manage a suicide crisis.
Screening: Administration of an assessment tool to identify persons in need of more in-depth
evaluation or treatment.
Screening Tools: Instruments and techniques (e.g., questionnaires, checklists, and selfassessment forms) used to evaluate individuals for increased risk of certain health problems.
Selected Reserve (SELRES): Drilling and training members of the National Guard and
Reserves, Individual Mobilization Augmentees, and full-time support Active Guard and
Reservists. This excludes members of the Individual Ready Reserve (IRR) and Inactive National
Guard (ING).
Service Member: A person appointed, enlisted, or inducted into a branch of the military
services, including Reserve Components (e.g., National Guard), cadets, or midshipmen of the
military service academies.
Stigma: Negative perception by individuals that seeking mental health care or other supportive
services will negatively affect or end their careers.
Suicidal Behaviors: Behaviors related to suicide, including preparatory acts, as well as suicide
attempts and deaths.
Suicide Ideation: Thinking about, considering, or planning suicide.
Suicide: Death caused by self-directed injurious behavior with an intent to die as a result of the
behavior.
Suicide Attempt: A non-fatal, self-directed, potentially injurious behavior with an intent to die
as a result of the behavior; might not result in injury.
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 Suicide Crisis: A suicide crisis, or potential suicide, is a situation in which a person is
attempting to kill him or herself or is seriously contemplating or planning to do so. It is
considered a medical emergency, requiring immediate suicide intervention and emergency
medical treatment.
Suicide Event Status (Pending and Confirmed)
•

Pending Suicide: A designation by AFME as the manner of death when the circumstances
are consistent with suicide, but the determination is not yet final. Final determination may
take many months. Importantly, pending (also known as suspected) suicides are included by
DSPO and AFMES when reporting suicide counts.

•

Confirmed Suicide: A designation by AFME when assigning suicide as the final
determination of the manner of death.

Suicide Rate: The average number of deaths by suicide in a fixed population per unit of time.
As suicide is relatively rare, the suicide rate is commonly standardized to deaths per 100,000
persons per year. A suicide rate is calculated by dividing the number of deaths by suicide in the
unit of time (in DoD, typically a calendar year) by the exposed population (in DoD, the average
of 12 monthly end-strengths).

42

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