Mil­i­tary’s ‘stag­ger­ing’ sui­cide rate

Fe­male vet­er­ans kill them­selves at nearly six times the rate of other women, and on par with male vets.

Los Angeles Times - - FRONT PAGE - By Alan Zarembo

New gov­ern­ment re­search shows that fe­male mil­i­tary vet­er­ans com­mit sui­cide at nearly six times the rate of other women, a star­tling find­ing that ex­perts say poses dis­turb­ing ques­tions about the back­grounds and ex­pe­ri­ences of women who serve in the armed forces.

Their sui­cide rate is so high that it ap­proaches that of male vet­er­ans, a find­ing that sur­prised re­searchers be­cause men gen­er­ally are far more likely than women to com­mit sui­cide.

“It’s stag­ger­ing,” said Dr. Matthew Miller, an epi­demi­ol­o­gist and sui­cide ex­pert at North­east­ern Uni­ver­sity who was not in­volved in the re­search. “We have to come to grips with why the rates are so ob­scenely high.”

Though sui­cide has be­come a ma­jor is­sue for the mil­i­tary over the last decade, most re­search by the Pen­tagon and the Vet­er­ans Af­fairs Depart­ment has fo­cused on men, who ac­count for more than 90% of the na­tion’s 22 mil­lion for­mer troops. Lit­tle has been known about fe­male vet­eran sui­cide.

The rates are high­est among young vet­er­ans, the VA found in new re­search com­pil­ing 11 years of data. For women ages 18 to 29, vet­er­ans kill them­selves at nearly 12 times the rate of non­vet­er­ans.

In ev­ery other age group, in­clud­ing women who served as far back as the 1950s, the vet­eran rates are be­tween four and eight times higher, in­di­cat­ing that the causes ex­tend far be­yond the psy­cho­log­i­cal ef­fects of the re­cent wars.

The data in­clude all 173,969 adult sui­cides — men and women, vet­er­ans and non­vet­er­ans — in 23 states be­tween 2000 and 2010.

It is not clear what is driv­ing the rates. VA re­searchers and ex­perts who re­viewed the data for The Times said there were myr­iad pos­si­bil­i­ties, in­clud­ing whether the mil­i­tary had dis­pro­por­tion­ately drawn women at higher sui­cide risk and whether sex­ual as­sault and other trau­matic ex­pe­ri­ences while serv­ing played a role.

What­ever the causes, the con­sis­tency across age groups sug­gests a long­stand­ing pat­tern.

“We’ve been miss­ing some­thing that now we can see,” said Michael Schoen­baum, an epi­demi­ol­o­gist and mil­i­tary sui­cide re­searcher at the Na­tional In­sti­tute of Men­tal Health who

was not part of the work.

The 2011 death of 24-yearold Katie Lynn Ce­sena is one of a dozen cases The Times iden­ti­fied in Los An­ge­les and San Diego coun­ties. Ce­sena’s death high­lights two likely fac­tors in the rates.

First, she had re­ported be­ing raped by a fel­low ser­vice mem­ber. The Pen­tagon has es­ti­mated that 10% of women in the mil­i­tary have been raped while serv­ing and an­other 13% sub­ject to un­wanted sex­ual con­tact, a deep-rooted prob­lem that has gained at­ten­tion in re­cent years as more vic­tims come for­ward.

The dis­tress forced Ce­sena out of the Navy, said her mother, Lau­rie Reaves.

She said her daugh­ter was be­ing treated for post­trau­matic stress dis­or­der and de­pres­sion at the VA Med­i­cal Cen­ter in San Diego and lived in fear of her pur­ported rapist — who was never pros­e­cuted — and his friends.

Ce­sena had started writ­ing a mem­oir and shared the be­gin­ning on Face­book. “I would like to ded­i­cate this book to the United States Navy and all the men and women who have bravely served our coun­try with hu­mil­ity and have been raped and were brave enough to tell some­one, whether any­thing came of it or not,” she wrote.

The sec­ond fac­tor was Ce­sena’s use of a gun, a method typ­i­cally pre­ferred by men.

In the gen­eral pop­u­la­tion, women at­tempt sui­cide more of­ten than men but suc­ceed less be­cause women usu­ally use pills or other meth­ods that are less lethal than firearms. Fe­male vet­er­ans, how­ever, are more likely than other women to have guns, gov­ern­ment sur­veys have shown.

In the new data, VA re­searchers found that 40% of the fe­male vet­er­ans who com­mit­ted sui­cide used guns, com­pared with 34% of other women — enough of a dif­fer­ence to have a small ef­fect on the rates.

An­other area of in­ter­est to re­searchers is the back­grounds of women who join the mil­i­tary.

Fe­male ser­vice mem­bers have al­ways been vol­un­teers, and their el­e­vated sui­cide rates across all gen­er­a­tions may be part of a larger pat­tern. Male vet­er­ans 50 and older — the vast ma­jor- ity of whom served dur­ing the draft era, which ended in 1973 — had roughly the same sui­cide rates as non­vet­eran men their age. Only younger male vet­er­ans, who served in the all-vol­un­teer force, had rates that ex­ceeded those of other men.

The dif­fer­ences sug­gest that the sui­cide rates may have more to do with who chooses to join the mil­i­tary than what hap­pens dur­ing their ser­vice, said Claire Hoffmire, the VA epi­demi­ol­o­gist who led the re­search. A more de­fin­i­tive ex­pla­na­tion would re­quire in­for­ma­tion not in­cluded in the data, such as when each vet­eran served and for how long.

Hoffmire pointed to re­cent re­search show­ing that men and women who join the mil­i­tary are more likely to have en­dured dif­fi­cult child­hoods, in­clud­ing emo­tional and sex­ual abuse.

Other stud­ies have found that Army per­son­nel — be­fore en­list­ment — had ele- vated rates of sui­ci­dal think­ing, at­tempts and var­i­ous men­tal health prob­lems. Those stud­ies did not break out the num­bers for women.

Though the U.S. mil­i­tary has long pro­vided ca­ma­raderie and a sense of pur­pose to men, it has been a harsher place for women. “They lack a sense of be­long­ing,” said Leisa Meyer, a his­to­rian at the Col­lege of Wil­liam and Mary in Vir­ginia and an ex­pert on women in the mil­i­tary.

The Pen­tagon capped the num­ber of women at 2% of the to­tal mil­i­tary un­til 1967. Women trained in sep­a­rate units un­til the late 1970s. His­tor­i­cally, they were nurses, which in wartime meant ex­po­sure to trauma.

In Afghanistan and Iraq, where road­side bombs were com­mon, women suf­fered un­prece­dented num­bers of ca­su­al­ties. But De­fense Depart­ment data show their ac­tive-duty sui­cide rate did not rise — a sharp con­trast to men, who saw their rate dou­ble.

The new data, which cover about half the vet­eran pop­u­la­tion, show that sui­cide rates rise sharply af­ter ser­vice mem­bers leave the mil­i­tary.

In all, 40,571 men and 2,637 women iden­ti­fied as vet­er­ans through mil­i­tary records killed them­selves over the 11 years in the data. The over­all re­sults were pub­lished on­line last month in the jour­nal Psy­chi­atric Ser­vices.

Sui­cide rates are usu­ally ex­pressed as the an­nual num­ber of deaths for ev­ery 100,000 peo­ple. For male vet­er­ans, that fig­ure was 32.1, com­pared with 20.9 for other men.

The num­bers were much fur­ther apart for women: 28.7 for vet­er­ans and 5.2 for every­body else.

A strat­i­fi­ca­tion of the data by age group — which was pro­vided to The Times — shows that young vet­er­ans face the great­est risk.

Among men 18 to 29 years old, the an­nual num­ber of sui­cides per 100,000 peo­ple were 83.3 for vet­er­ans and 17.6 for non­vet­er­ans.

The num­bers for women in that age group: 39.6 and 3.4.

The dif­fer­ences be­tween fe­male vet­er­ans and other women are less ex­treme in older age groups but still con­sid­ered alarm­ingly high by re­searchers.

The states in the study rep­re­sent about half the na­tion’s vet­er­ans but did not in­clude Cal­i­for­nia.

In the lo­cal cases iden­ti­fied by The Times, one pat­tern stood out: Sev­eral women had been dis­charged early for psy­chi­atric or med­i­cal prob­lems.

A back in­jury forced out Sara Leather­man in 2009 and con­tin­ued to cause her pain. She was also suf­fer­ing from trau­matic mem­o­ries of maim­ing and death she wit­nessed as a medic in Iraq, said her grand­mother, Vir­ginia Um­baugh.

Leather­man was 24, at­tend­ing com­mu­nity col­lege in La Mesa in San Diego County and re­ceiv­ing treat­ment for PTSD when she hanged her­self in her grand­mother’s shower in 2010, Um­baugh said.

The war, how­ever, was not the only fac­tor. Leather­man had tried to kill her­self with pills while sta­tioned in Texas, be­fore go­ing to Iraq, said Um­baugh, who raised her. “I don’t think there’s any one an­swer,” she said.

In other cases, vet­eran sta­tus seemed al­most in­ci­den­tal, with decades pass­ing since mil­i­tary ser­vice and no clear link to the bro­ken re­la­tion­ships, fi­nan­cial prob­lems, men­tal health trou­bles and other dis­ap­point­ments that can ac­cu­mu­late in the course of a life.

Linda Raney was 65 years old in 2011 and deal­ing with prob­lems that mounted for sev­eral years: the death of her sis­ter in a car ac­ci­dent, money and health dif­fi­cul­ties.

She was living with an aunt in Ac­ton and was dis­ap­pointed that she didn’t meet the fi­nan­cial re­quire­ments for the VA to help her get her own place.

“She didn’t want to be a bur­den on her aunt,” said her nephew, Kevin Pearcy. One af­ter­noon, she called him to say good­bye, then com­mit­ted sui­cide with pre­scrip­tion pills.

She had never talked much about her time in the Air Force.

“I don’t know her spe­cialty,” Pearcy said. “She was very young.”

KATIE LYNN CE­SENA, left, who had re­ported be­ing raped by a fel­low ser­vice mem­ber, killed her­self in 2011 at age 24. Linda Raney, cen­ter, was 65 when she com­mit­ted sui­cide in 2011. Sara Leather­man, suf­fer­ing from PTSD, took her own life in 2010 at age 24.

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