Suicide Surveillance in the U.S. Military—Reporting and Classification Biases in Rate Calculations
- 1 September 2004
- journal article
- case report
- Published by Wiley in Suicide and Life-Threatening Behavior
- Vol. 34 (3), 233-241
- https://doi.org/10.1521/suli.34.3.233.42785
Abstract
The military has a well-defined population with suicide prevention programs that have been recognized as possible models for civilian suicide prevention efforts. Monitoring prevention programs requires accurate reporting. In civilian settings, several studies have confirmed problems in the reporting and classification of suicides. This analysis evaluated whether suicides were underreported or misclassified under accident or undetermined manner of death in the military system. We reviewed all 1998 and 1999 military deaths using official death reports and compared these data with additional sources, most importantly the DoD Medical Mortality Registry. We assessed for evidence of expressed suicidal intent and past psychiatric history among deaths classified as undetermined and accidents due to gunshot, overdose, drowning, falls, or asphyxia. Using sources other than official records, we found 17% more suicides than were reported, and an additional 4% of deaths that were suspicious for suicide. This study suggests that reporting and classification errors may account for 21% additional suicides in the military. These findings are comparable to rates seen in civilian studies and add to the literature regarding the problems inherent in using administrative death classification data for medical surveillance purposes.Keywords
This publication has 22 references indexed in Scilit:
- Risk of suicide and related adverse outcomes after exposure to a suicide prevention programme in the US Air Force: cohort studyBMJ, 2003
- Mental Disorders Among U.S. Military Personnel in the 1990s: Association With High Levels of Health Care Utilization and Early Military AttritionAmerican Journal of Psychiatry, 2002
- Trends in adolescent suicide: misclassification bias?American Journal of Public Health, 2001
- Life and Death in the US ArmyJAMA, 1990
- Life and death in the US Army. In Corpore sanoJAMA, 1990
- Miscounting SuicidesSuicide and Life-Threatening Behavior, 1988
- Suicide in the United States MilitaryPsychiatric Annals, 1987
- Alcohol, Firearms, and Suicide Among YouthJAMA, 1987
- Alcohol, firearms, and suicide among youth. Temporal trends in Allegheny County, Pennsylvania, 1960 to 1983JAMA, 1987
- Suicide in the U.S. Army: Epidemiological and Periodic AspectsSuicide and Life-Threatening Behavior, 1987