African American Veterans Incidents of Suicide

Incidents of Suicide Among African American Veterans

1.) Background

African American Male veterans are reported to be twice as likely to commit suicide compared to the civilians on the streets. So far, most of the information regarding suicide among veterans is derived from the ones accessing healthcare from the VA Department. However, figures show that 75% of veterans do access healthcare via VA. The study shows that African American veterans are 58% more likely to commit suicide by using a firearm. The research also shows that the number of veterans with limitations on daily life activity is high. Such limitations contribute to their tendency to commit suicide. It suggests that there is a need for community interventions. Clinicians have also been urged to detect any signs of the likelihood of a veteran to commit suicide, and to review their access to guns.[footnoteRef:1] [1: Mark Kaplan S., Nathalie Huguet, Bentson H. McFarland, and Jason T. Newsom. \\\\\\\"Suicide among male veterans: a prospective population-based study.\\\\\\\" Journal of Epidemiology & Community Health 61, no. 7 (2007): 619.]

Soldiers have always fought to defend America; from the time the nation was founded. Usually, ordinary soldiers and even the highly trained combat personnel complete their service with the military without major injuries. However, such a probability does not mean that all of them leave the service unscathed. There are some veterans that leave the service with serious injuries that limit their life activities significantly. The scars are both physical and psychological. Such effects have far-reaching effects on the veterans and their families. One of the problems include mental disorders, depression, stress among many others are signs of the effects cost of military service among the veterans. The invisible wounds are also commonly manifested through post traumatic stress disorders, commonly referred to as PSTD.[footnoteRef:2] Mr. James Peake who served as the secretary of the Department of Veteran Affairs initiated a program to assess the chances of veterans committing suicide[footnoteRef:3]. The Veterans Health Administration has set up improved its mental health services aimed at preventing suicide among veterans.[footnoteRef:4], [footnoteRef:5] Unfortunately, despite the noble efforts made by the VHA, the rates of suicide among the veterans have not changed[footnoteRef:6]. Although there has been plenty of research regarding the interaction of risk factors and how they lead to higher risk of suicide, there is little information from multivariable models that could practically be applied by clinicians.[footnoteRef:7],[footnoteRef:8],[footnoteRef:9] Two reports in recent times show that the predictive model that utilizes information gathered from administrative files can help to pick out the veterans more likely to commit suicide.[footnoteRef:10],[footnoteRef:11] According to the Center for Health Statistics and the CDCP, uploading veteran information is not part of their daily routine reporting of death protocol from the various states. It is, therefore not possible to access accurate rates of death among American veterans compiled from the whole of the US.[footnoteRef:12] [2: Steven, Koven G. \\\\\\\"PTSD and Suicides Among Veterans—Recent Findings.\\\\\\\" Public Integrity 19, no. 5 (September 2017): 500.] [3: Matthew, Miller, et al. \\\\\\\"Veterans and Suicide: A Reexamination of the National Death Index-Linked National Health Interview Survey.\\\\\\\" American Journal of Public Health 102, no. S1 (March 2, 2012): S154] [4: Ira Katz, \\\\\\\"Lessons Learned from Mental Health Enhancement and Suicide Prevention Activities in the Veterans Health Administration.\\\\\\\" American Journal of Public Health, (March 02, 2012.), S14-S165 Substance Abuse and Mental Health Services Administration, (DHHS/PHS), and (DHHS/PHS) Office of the Surgeon General. \\\\\\\"2012 National Strategy for Suicide Prevention: Goals and Objectives for Action. A Report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention.\\\\\\\" (September 1, 2012): ERIC.] [5: ] [6: John McCarthy, F., et al. \\\\\\\"Predictive Modeling and Concentration of the Risk of Suicide: Implications for Preventive Interventions in the US Department of Veterans Affairs.\\\\\\\" American Journal of Public Health 105, no. 9 (September 2015): 1935.] [7: Hanga Galfalvy C., Maria A. Oquendo, and J. John Mann. \\\\\\\"Evaluation of clinical prognostic models for suicide attempts after a major depressive episode.\\\\\\\" Acta Psychiatrica Scandinavica 117, no. 4 (2008): 244.] [8: Jayne, Cooper, Navneet Kapur, Joel Dunning, Else Guthrie, Louis Appleby, and Kevin Mackway-Jones. \\\\\\\"A clinical tool for assessing risk after self-harm.\\\\\\\" Annals of emergency medicine48, no. 4 (2006): 459] [9: Quyen Tiet, Q., Mark A. Ilgen, Hilary F. Byrnes, and Rudolf H. Moos. \\\\\\\"Suicide attempts among substance use disorder patients: an initial step toward a decision tree for suicide management.\\\\\\\" Alcoholism: Clinical and Experimental Research 30, no. 6 (2006): 1000.] [10: Ronald, Kessler, C., Christopher H. Warner, Christopher Ivany, Maria V. Petukhova, Sherri Rose, Evelyn J. Bromet, Millard Brown et al. \\\\\\\"Predicting suicides after psychiatric hospitalization in US Army soldiers: the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).\\\\\\\" JAMA psychiatry 72, no. 1 (2015): 53.] [11: Truyen, Tran, Wei Luo, Dinh Phung, Richard Harvey, Michael Berk, Richard Lee Kennedy, and Svetha Venkatesh. \\\\\\\"Risk stratification using data from electronic medical records better predicts suicide risks than clinician assessments.\\\\\\\" BMC psychiatry 14, no. 1 (2014): 76.] [12: Robert Bossarte M., Cynthia A. Claassen, and Kerry L. Knox. \\\\\\\"Evaluating Evidence of Risk for Suicide Among Veterans.\\\\\\\" Military Medicine 175, no. 10 (October 2010): 703. ]

2.) Method section

Veteran Health Administration, records of the cause of death from CDCP and vital statuses data will be used to compute suicide rates among veterans in the US. Information from the states on the on suicide among veterans, their age and gender will also be used. The rates of suicide expressed as deaths per 1000 persons will be projected for the states that wholly participate in the National Violent Death Reporting System (NVDRS) from 2005 to 2008. The suicide rates among those accessing VHA services will be computed using data from VHA drawn from the National Patient Care Data Base basing on methods described previously. The study will find out the patients with inpatient and outpatient access to VHA services from 2005 to 2008 with no such contact thereafter. The study will also probe NDI to identify the vital statuses of such individuals and the cause of death for the ones that died. The rate of veteran suicide deaths will be provided by NVDRS, irrespective of whether they accessed VHA or not. The information will be provided by sex, year, category and age for each state using their coding methods.[footnoteRef:13] [13: Ira Katz, \\\\\\\"Lessons Learned from Mental Health Enhancement” S106]

The NDVRS and the states have an agreement that precludes disclosure of information regarding decedents. Thus, non users of VHA will be estimated by subtracting those accessing VHA in the states under analysis from the total number of veterans in such states. Predictive analytics Software Statistics 18wil be used (SPSS Statistics, Hong Kong). The generalized linear modeling command will be applied to arrive at comparisons of suicide rates, along with the Poisson log linear modeling for counts.[footnoteRef:14] [14: Ibid]

3.) Reflection of where you answer the given questions