The Department of Defense and its partners continue to examine how various military-specific stressors could contribute to suicide-related behaviors and mortality in the force.
The 2022 Department of Defense Annual Report on Suicide in the Military provides some insights about active component service members who died by suicide:
- The suicide mortality rate for the active component was 25.1 deaths per 100,000 population.
- Firearm was the most common mechanism of injury.
- 45% had a known mental health diagnosis.
- Within 90 days prior to death, 42% of decedents had known relationship problems, 26% had known legal/administrative problems, and 26% had known work-related problems.
Although suicide is a serious public health problem, it is treatable. All providers in the Military Health System should be aware of warning signs in their patients and refer them to mental health specialists for screening and treatment whenever suicide risk may be an issue.
Go to the DODSER annual report archive to view previous years' reports.
Suicide Prevention Crisis Services
Warning Signs and Screening
Note: This content is derived from the 2024 VA/DOD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide. For the latest clinical practice guideline for this condition, visit https://www.healthquality.va.gov/HEALTHQUALITY/guidelines/MH/srb/.
Common Warning Signs
Common warning signs of suicidal behavior (for example, a person-specific thought, feeling, physical sensation, behavior, or any combination of the foregoing that indicates the presence of acute risk) include:
- Suicide related communication (for example, suicide note, mention of wishing to die)
- Seeking access to or recent use of lethal means (for example, buying a gun, stockpiling harmful medications)
- Preparation for suicide (for example, giving items away)
Screening for and Assessing Suicide-related Thoughts and Behaviors
The 2024 VA/DOD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide and Pocket Guide for Patients at Risk for Suicide outline a few important procedures for clinicians engaged in screening for and assessing suicide risk.
- Use a validated screening tool for the general population, such as the Columbia-Suicide Severity Risk Scale (C-SSRS), Suicide Cognition Scale - Revised, or PHQ-9.
- Conduct a comprehensive assessment of each patient’s risk and protective factors. Examples of risk factors for suicide include, but are not limited to, self-directed violence (SDV) thoughts and behaviors, current psychiatric conditions and current or past mental health treatment, psychiatric symptoms, social determinants of health and adverse life events, availability of lethal means, physical health conditions, and demographic characteristics. Protective factors may include access to mental health care, sense of connectedness, problem-solving skills, sense of spirituality, mission or purpose, physical health, employment, or social and emotional well-being.
- Do not use a single instrument or method when evaluating suicide risk. At a minimum, use a validated assessment tool and conduct a clinical interview of the patient. Using multiple methods enables clinicians to develop more nuanced understandings of their patients’ risk levels, which feeds into more individualized treatment and management plans.
Treatment for Suicide-related Thoughts and Behaviors
No treatment was associated with a “strong for” recommendation based on the evidence. The only non-pharmacologic treatment with “weak for” recommendation for suicide attempt or suicide ideation was cognitive behavioral therapy-based therapy focused on suicide prevention. Pharmacologic treatments with “weak for” recommendations included clozapine to reduce the risk of suicide attempts for patients with schizophrenia or schizoaffective disorder and ketamine infusion for short-term reduction in suicidal ideation.
Firearm and Means Safety
Health care providers should talk with their patients about firearm safety procedures as well as other means safety procedures (for example, safe medication storage) on a regular basis.
Resources and clinical support tools are available to help health care providers and military leaders develop competence in discussing firearm and means safety.
We have created some suicide risk clinical support tools for providers, patients, families, and military leaders based on the guidance in the CPG.
Patient Tools
- Safety Plan Worksheet (2024) The Safety Plan Worksheet, designed to be printed or saved electronically, enables health care providers and patients to collaboratively identify a patient’s stressful triggers, warning signs, sources of support, coping strategies and ways to access health care and crisis assistance
- Crisis Response Plan (2024) Printable, collaborative safety planning tool for trained providers and their patients to create a dynamic plan to reduce patient risk for suicidal behavior
Family Tool
Line Leader Tools