Undercounting Suicide in the Military

In Calculation of Suicide Rates, Numbers Not Always Straightforward:

An analysis of Pentagon data shows that the Department of Defense uses numbers that may underestimate its suicide rate. A different methodology, like one employed by the Centers for Disease Control and Prevention, would result in a military rate equivalent to or above the comparable civilian rate, experts say.

Bob Anderson, head statistician for mortality statistics at the C.D.C., said the Pentagon’s approach resulted in a suicide rate that “will be lower than it should be.” 

“It will underestimate the mortality rate,” he said. 

The difference is about more than math. The suicide rate is perhaps the most important data point for tracking trends in suicide and comparing different populations. 

To determine the rate, statisticians divide the number of suicides in a year by the total population.

The first number is fairly straightforward: for the entire military, there were 309 active-duty suicides in 2009, the most recent year for which comparable civilian data is available. (The military number includes National Guard and reserve troops who were on active duty when they killed themselves.)

But the total military population is not as simple to estimate. Not only are service members joining and leaving the military constantly, National Guard and reserve troops are also continuously flowing on and off active-duty rosters. How one estimates the number of Guard and reserve troops on active duty at any one time clearly affects the total military population. 

Population discrepancies are not just limited to the military either. One of the biggest problems with the UCR and other crime statistics and suicide rate measurements is that they fail to take into account populations shifts and mobility (though the CDC does us the "one day snapshot" average in some cases as a control).

Also, this article makes it sound like counting the first part, the suicide itself, is a given. It isn't. Law enforcement, medical examiners and other organizations (like the Military) may "unfound" reported suicides for a variety of reasons (request of the family, to make the organization look better, to downplay its extent, etc.). As Jack Douglas warned years ago, we should always be leery of "official statistics" and what methodologies are being used to arrive at these figures.

Nonetheless, the problem is worse than the official numbers have indicated for a long time.

There is no dispute on one issue: the military rate has been climbing faster than the civilian rate. According to the Pentagon, the military rate of 18.5 suicides per 100,000 service members in 2009 was up from 10.3 suicides per 100,000 in 2002 — an 80 percent increase. A comparable civilian suicide rate rose by about 15 percent in the same period. 

An accompanying article in the Times makes the point even more salient, and makes it clear that after decades of research, we're nowhere near understanding the causes of the "never ending war."

Though the Pentagon has commissioned numerous reports and invested tens of millions of dollars in research and prevention programs, experts concede they are little closer to understanding the root causes of why military suicide is rising so fast. 

“Any one variable in isolation doesn’t explain things,” said Craig J. Bryan, associate director of the National Center for Veterans Studies at the University of Utah. “But the interaction of all of them do. That’s what makes it very difficult to solve the problem. And that’s why we haven’t made advances.”

Intersectionality (reciprocal attachments among variables) is a growing field within suicidology these days and its growth should be applauded. The only way we are ever going to get to the root cause of suicide is to recognize the fact that it's rarely ever one single variable that causes it, but instead a perfect storm of tribulations which increase the risk of mortality.

Cross posted to: The Cranky Sociologists

Law Enforcement Deaths 2012

Wanna know why the IACP, the National Association of Chiefs of Police, the Fraternal Order of Police, and virtually every other organization that advocates on behalf of the police think the NRA and its extreme policies on guns are loony? Because of this:

FBI Releases 2012 Law Enforcement Officers Killed in Line of Duty:

According to preliminary statistics released today by the FBI, 47 law enforcement officers were feloniously killed in the line of duty in 2012. The total number of officers killed is 25 fewer than the 72 officers who died in 2011. By region, 22 officers were killed as a result of criminal acts that occurred in the South, eight officers in the West, six officers in the Northeast, five officers died due to incidents in the Midwest, and six officers were killed in the U.S. territories of Puerto Rico and the Virgin Islands.

Offenders used firearms in 43 of the 47 felonious deaths. These included 30 incidents with handguns, seven incidents with rifles, and three incidents with shotguns. The type of firearm was not reported in three of the incidents.  Twenty of the slain officers were wearing body armor at the times of the incidents. Six of the officers fired their own weapons and two officers attempted to fire their service weapons. Three victim officers had their weapons stolen; however, none of the officers were killed with their own weapons.

Apparently the NRA's brain dead "the only way to stop a bad guy with a gun is a good guy with a gun" didn't working out too well for those 43 dead police officers.

To the Graduating Class of 2013

And to all classes past and future, an edited version of one of my favorite writers David Foster Wallace's commencement address from 2005.  This is Water.



And best of luck to you.

Headline of the Duh

Psychiatry's New Guide Is Out Of Touch With Science:

Just weeks before the long-awaited publication of a new edition of the so-called bible of mental disorders, the federal government’s most prominent psychiatric expert has said the book suffers from a scientific “lack of validity.”

The expert, Dr. Thomas R. Insel, director of the National Institute of Mental Health, said in an interview Monday that his goal was to reshape the direction of psychiatric research to focus on biology, genetics and neuroscience so that scientists can define disorders by their causes, rather than their symptoms.

Well, he's half right. The DSM is completely lacking in scientific validity and has been so since the first edition came out in the 1960's. We should not, however, be focusing more on the "biology, genetics or neuroscience" of behavioral disorders, but instead on labeling and social control.

“As long as the research community takes the D.S.M. to be a bible, we’ll never make progress,” Dr. Insel said, adding, “People think that everything has to match D.S.M. criteria, but you know what? Biology never read that book.”

Neither did sociology, because most Labeling theorists would tell you that mental illness is a subjective label applied to behaviors that violate social norms. You can dig for all the biological or genetic "causes" you want: at the end of the day, it's the behavior that is being labeled as "mentally ill."

But don't expect the psychiatric-industrial complex to  roll over in the face of criticism.

Dr. Jeffrey Lieberman, the chairman of the psychiatry department at Columbia and president-elect of the American Psychiatric Association, which publishes the D.S.M., said that the new edition’s refinements were “based on research in the last 20 years that will improve the utility of this guide for practitioners, and improve, however incrementally, the care patients receive.”

He added: “The last thing we want to do is be defensive or apologetic about the state of our field."

LOL. They should be down on their hands and knees, begging for absolution and forgiveness from the millions of lives and minds ruined by unscientific diagnoses and chemical lobotomies.
But what do a bunch of sociologists know?

Cross posted to: The Cranky Sociologists

To Join The Choir Invisible

Suicide Rates Rise Sharply:

Suicide rates among middle-aged Americans have risen sharply in the past decade, prompting concern that a generation of baby boomers who have faced years of economic worry and easy access to prescription painkillers may be particularly vulnerable to self-inflicted harm.

More people now die of suicide than in car accidents, according to the Centers for Disease Control and Prevention, which published the findings in Friday’s issue of its Morbidity and Mortality Weekly Report. In 2010 there were 33,687 deaths from motor vehicle crashes and 38,364 suicides. 

Suicide has typically been viewed as a problem of teenagers and the elderly, and the surge in suicide rates among middle-aged Americans is surprising. 

Not sure why it's "surprising". Suicide rates generally increase as one goes up the age demographic ladder. There is sometimes a small decline in the 55-64 age group, but generally rates are lowest among teenagers and highest among the elderly (especially the oldest of the old, 85+).

From 1999 to 2010, the suicide rate among Americans ages 35 to 64 rose by nearly 30 percent, to 17.6 deaths per 100,000 people, up from 13.7. Although suicide rates are growing among both middle-aged men and women, far more men take their own lives. The suicide rate for middle-aged men was 27.3 deaths per 100,000, while for women it was 8.1 deaths per 100,000. 

The most pronounced increases were seen among men in their 50s, a group in which suicide rates jumped by nearly 50 percent, to about 30 per 100,000. For women, the largest increase was seen in those ages 60 to 64, among whom rates increased by nearly 60 percent, to 7.0 per 100,000.

Suicide rates can be difficult to interpret because of variations in the way local officials report causes of death. But C.D.C. and academic researchers said they were confident that the data documented an actual increase in deaths by suicide and not a statistical anomaly. While reporting of suicides is not always consistent around the country, the current numbers are, if anything, too low. 

“It’s vastly underreported,” said Julie Phillips, an associate professor of sociology at Rutgers University who has published research on rising suicide rates. “We know we’re not counting all suicides.” 

Exactly. Nice to see Jack Douglas' "The Social Meaning of Suicides" dissection of official statistics get brought out in a roundabout way. The suicide taboo, as Douglas pointed 45 years ago, still leads to the deliberate misclassification of deaths that are rather obviously suicide.

The reasons for suicide are often complex, and officials and researchers acknowledge that no one can explain with certainty what is behind the rise. But C.D.C. officials cited a number of possible explanations, including that as adolescents people in this generation also posted higher rates of suicide compared with other cohorts. 

“It is the baby boomer group where we see the highest rates of suicide,” said the C.D.C.’s deputy director, Ileana Arias. “There may be something about that group, and how they think about life issues and their life choices that may make a difference.” 

The rise in suicides may also stem from the economic downturn over the past decade. Historically, suicide rates rise during times of financial stress and economic setbacks. “The increase does coincide with a decrease in financial standing for a lot of families over the same time period,” Dr. Arias said. 

Couple of things: one, there is nothing in the historical data to suggest that suicide increases during economic downturns (see this previous post). If Durkheim is correct, and suicide increases when anomie increases, then perhaps higher unemployment could lead to higher normlessness and a jump in suicide. But it's not the financial condition as much as it is anomie in individuals already prone to normlessness. Not to mention, the suicide rates were rising before the Great Recession hit. This isn't to say a bad economy isn't correlated at all, but causation seems to difficult to prove.

Second, as much as it pains me to write this (given my aversion to Baby Boomers in general), I really don't think this is generational behavior either. From the long term vital statistics I've seen, there has not been an increase in suicidal behavior each time this generation moved into another phase of life. When they were teenagers in the 60's it didn't happen, nor in their 20's in the 70's, 30's in the 80's, and so on. Given the Boomer's obsession with youth and hanging on way past their expiration date (in terms of work, popular culture, etc.), it would seem to be quite the opposite.

So what could it be? A myriad of things, but the article notes an increase in poisonings, which I find interesting.

Although most suicides are still committed using firearms, officials said there was a marked increase in poisoning deaths, which include intentional overdoses of prescription drugs, and hangings. Poisoning deaths were up 24 percent over all during the 10-year period and hangings were up 81 percent. 

The easy availability of Big Pharma has certainly aided those who want to go out using more passive methods. Although you could also make the same argument about the availability of rope.

I think medical-related (health-related) suicides aren't being separated here either (persons who end their lives already sick with a terminal or debilitating condition). If there is an age-related component to the increase, it's the simple correlation that as morbidity increases, so too does mortality. People get sicker when they get older = people end their lives at a greater rate.

Technology is also playing a role in this as well. To the cyber-utopian's dismay, the research available today shows that despite all the interconnectedness of social media, facebook, twitter and so on, people are more socially isolated than ever. And as Durkheim warned 100 + years ago, when social isolation and marginalization increase, so too does suicide.

I'll have to dig through the report for more observations, but at first blush, the news is extremely disappointing. We've seen rates of suicide skyrocket among active duty and former members of the military since 2003, and now we can confirm that it is increasing exponentially in the general population as well.

When I wrote "The Never Ending War" three years ago, the post was ostensibly about suicide among returning veterans of war. But the never-ending battle to bring suicide out of the shadows of stigma and shame and educate the public about its prevalence and consequences continues, whether we are talking about veterans or just the general citizenry. And the more we conceptualize the problem as an individual phenomenon, and not the social and public health epidemic it has become, the more lives will continue to be lost.

We have wars on terror, drugs, immigration, crime, poverty, fat and every other inanimate object imaginable, is it time (forgive me) to launch a War on Suicide?

Cross Posted To: The Cranky Sociologists

Academic Steroids: Part Whatever

Attention Deficit Drugs Face New Campus Rules:

Fresno State is one of dozens of colleges tightening the rules on the diagnosis of A.D.H.D. and the subsequent prescription of amphetamine-based medications like Vyvanse and Adderall. Some schools are reconsidering how their student health offices handle A.D.H.D., and even if they should at all.

Various studies have estimated that as many as 35 percent of college students illicitly take these stimulants to provide jolts of focus and drive during finals and other periods of heavy stress. Many do not know that it is a federal crime to possess the pills without a prescription and that abuse can lead to anxiety, depression and, occasionally, psychosis.

Although few experts dispute that stimulant medications can be safe and successful treatments for many people with a proper A.D.H.D. diagnosis, the growing concern about overuse has led some universities, as one student health director put it, “to get out of the A.D.H.D. business.”

The most surprising thing about this is the percentage...we're talking over a third of college students amping up in some capacity with prescription amphetamines come finals time. And while limiting access to the drugs via campus health centers is a good start, this is more of a legal affairs issue than it is a campus health issue.

Changes like these, all in the name of protecting the health of students both with and without attention deficits, involve legal considerations as well. Harvard is being sued for medical malpractice by the father of a student who in 2007 received an A.D.H.D. diagnosis and Adderall prescription after one meeting with a clinical nurse specialist.

You knew this had to involve law suits in some capacity. Decisions like these have less to do with the welfare and best interests of the students, and everything to do with covering the colleges collective back sides from litigation.

But asking students to take the equivalent of virginity pledges when it comes to abusing stimulants ("I am making a commitment to myself, my family, and my Creator, that I will abstain from amphetamines of any kind before graduation") is going to do little to stop the push back from the pro-A.D.H.D. crowd.

Still, many student health departments regard A.D.H.D., a neurological disorder that causes severe inattention and impulsiveness, as similar to any other medical condition. Eleven percent of American children ages 4 to 17 — and 15 percent of high school students — have received the diagnosis, according to a survey by the Centers for Disease Control and Prevention.

New college policies about A.D.H.D. tend not to apply to other medical or psychiatric conditions — suggesting discrimination, said Ruth Hughes, the chief executive of the advocacy group Children and Adults With Attention-Deficit/Hyperactivity Disorder. Such rules create “a culture of fear and stigma,” she said, adding that if students must sign a contract to obtain stimulants, they should have to do so for the painkillers that are also controlled substances and are known to be abused.

Which is absurd given that painkillers are not academic steroids and are not used to cheat (er, perform better) on tests, papers, and so forth. Talk about a straw man. 

And are we really going to hear the cries of "discrimination" from these people? That's like saying athletes suspected of using PED's are being "discriminated" against, or that wanting to cut down on cheating and abuse is just a "culture of fear and stigma."

I'm also bothered by the phrase "A.D.H.D, a neurological disorder..." It's a behavioral diagnosis (label) with no grounding whatsoever in neurology, biology or anything that meets the scientific method. In fact, new evidence suggests that the behavior so labeled as attention deficit may actually be nothing more than sleep disorders.

For some people — especially children — sleep deprivation does not necessarily cause lethargy; instead they become hyperactive and unfocused. Researchers and reporters are increasingly seeing connections between dysfunctional sleep and what looks like A.D.H.D., but those links are taking a long time to be understood by parents and doctors.

A number of studies have shown that a huge proportion of children with an A.D.H.D. diagnosis also have sleep-disordered breathing like apnea or snoring, restless leg syndrome or non-restorative sleep, in which delta sleep is frequently interrupted.

I had forgotten about "restless leg syndrome," better known as The Rockettes Disease. But seriously...

One study, published in 2004 in the journal Sleep, looked at 34 children with A.D.H.D. Every one of them showed a deficit of delta sleep, compared with only a handful of the 32 control subjects.

There has been less research into sleep and A.D.H.D. outside of childhood. But a team from Massachusetts General Hospital found, in one of the only studies of its kind, that sleep dysfunction in adults with A.D.H.D. closely mimics the sleep dysfunction in children with A.D.H.D.

Thakkar also notes the correlation between the rise in sleep disorders and the explosion of A.D.H.D in the 1990's...right around the time the internets exploded as well.

And to illustrate the very subjectiveness of the diagnosis that I and others have been railing about for years, this:

As it happens, “moves about excessively during sleep” was once listed as a symptom of attention-deficit disorder in the Diagnostic and Statistical Manual of Mental Disorders. That version of the manual, published in 1980, was the first to name the disorder. When the term A.D.H.D., reflecting the addition of hyperactivity, appeared in 1987, the diagnostic criteria no longer included trouble sleeping. The authors said there was not enough evidence to support keeping it in.

"The authors"...I love that, like the DSM is a work of fiction (cough).

One would also assume that the removal of the sleep criteria was based solely on money. There simply isn't as much money to be made in sleep disorders as there is in the ever-expanding criteria for A.D.H.D.

At the end of the day, colleges and universities are fighting a losing battle here. As the first article notes, students are more likely to bring their prescriptions with them to campus. And lacking that, why bother with the health center when you can score Adderall via the underground, black market (Biff's fraternity brother knows a dude who knows a dude who...)? It's everywhere.

This is a classic case of the fish rotting from the head down. Until we recognize the power of the psychiatric-industrial complex and Big Pharma to keep imposing its biomedical view of madness on every single social behavior, we're doomed. 

And like mold, its spread is harder to stop the longer we wait.

Cross posted to: The Cranky Sociologists

The Right to Keep and Bear Muskets

Best Gun Control Ad Ever:



Via the Leiter Reports (and cross-posted to The Cranky Sociologists)