DHA-Public Health Army Suicide Study Emphasizes Firearm Storage, Safety Policies, as Effective Strategies in Suicide Prevention

DHA-Public Health Army Suicide Study Emphasizes Firearm Storage, Safety Policies, as Effective Strategies in Suicide Prevention

If you or someone you know is in crisis, contact the Veteran/Military Crisis Line for immediate assistance. Dial 988; then press 1.

Every September, the Department of Defense and military services support Suicide Prevention Month as a way of drawing attention to the resources available to prevent service member suicides.

As part of their larger suicide prevention efforts, the DOD and services also track "all cause" mortality data, including suicide, as a way of identifying and understanding the occupational exposures that increase risk of premature death.

"This is highly dependent on using quality cause-of-death data," said Essie Pfau, chief of the Division of Behavioral & Social Health Outcomes Practice at Defense Health Agency-Public Health in Aberdeen, Maryland. "For example, gunshot wounds accounted for a substantial percentage of suicides. This information is critical for approaches to prevent suicide, including firearm and other lethal means safety. More broadly, these data can be used to inform the development and refinement of current and future prevention and health planning efforts, to include allocation of resources."

Pfau's team, often referred to as the BSHOP, contributed to a study titled "U.S. Army Mortality Surveillance in Active Duty Soldiers, 2014-2019" published in the May 2024 edition of the Medical Surveillance Monthly Report, or MSMR, published by the DHA.

As part of the study, the report's authors noted "this report provides more accurate mortality surveillance for the Army population and is the only all-cause mortality report published by the Defense Health Agency since 2016."

"Every death is a significant loss," said Maisha Toussaint, chief of the BSHOP surveillance branch, and one of the study's authors. "While the scientific community has identified risk factors of suicidal behavior, we must be mindful that each case is unique, as are the number and extent of risk factors experienced by the individual."

Toussaint said based on academic literature and what is known about suicidal behavior, there are some recommended actions her team follows in support of suicide prevention efforts, including:

• Further investigate protective factors
• Work to understand the social determinants of health that contribute to wellbeing and behavioral health
• Regularly evaluate those programs and services for effectiveness to ensure they are reaching the intended populations and producing meaningful changes in immediate and long-term outcomes
• Ensure best practices and latest evidence are used to implement prevention at every opportunity-from the community to the hospital

Although this report did not focus on stressors related to suicidal behavior, Toussaint said BSHOP's suicidal behavior surveillance reporting and other studies of suicidal behavior within military populations have indicated some life stressors, including relationship problems, work-related problems, legal issues, and/or financial stress.

"These findings highlight the importance of considering interactions between individuals and their life circumstances, both of which have implications for wellbeing and health," said Toussaint.

As part of their report, the study's authors recommended more targeted public health campaigns emphasizing firearm storage and safety.

"Suicide by gunshot wound was the leading cause of death overall-within several demographic groups-and was indicated as the method for 65% of suicides over the surveillance period," said Toussaint. "As scientists, we would be remiss not to expound on this key finding, in particular the relevance of gun safety and storage, which has been deemed an impactful approach to reducing suicides based on decades of evidence-based research."

Toussaint said these recommendations are also aligned with the recommendations proposed in 2022 by the Suicide Prevention and Response Independent Review Committee, or SPRIRC, which included establishing and updating gun control and safety policies to include requiring all privately owned weapons on DOD military property to be registered and properly stored, and implementing waiting periods and minimum age requirements for privately owned weapons and ammunition purchases on DOD property.

There is no one most-effective approach to prevent suicides, said Toussaint. Suicide prevention requires a multimodal approach to promote protective factors and mitigate risk factors for individuals, families, and communities.

"A combination of strategies must be employed to include community based programs and services that offer early referral and access to quality behavioral health services, alongside policy actions to implement and sustain initiatives concerning firearm access and safety," said Toussaint.

The report by the SPRIRC and BSHOP's A Decade of BH EPICON: Lessons Learned publication include a variety of public health approaches for consideration.

"The key findings reported in this article are not new information," said Toussaint. "However, this is the first time we have emphasized firearm safety and storage, which are strategies strongly supported by data reported in the civilian literature. With gunshot wounds being the most common method of death by suicide, and with suicide rates continuing to increase, discussions about firearm safety and storage are crucial. Furthermore, emphasis is needed on evaluating the effectiveness of this and other prevention strategies among military populations."

Resources for Service Members, Veterans and Families

• DOD Suicide Prevention Spotlight
• Military Crisis Line: Dial 988, then press 1; or text 838255
• Military OneSource

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