A "Suicide Epidemic Among Veterans"?
By streiff Posted in Media | War — Comments (19) / Email this page » / Leave a comment »
They are the casualties of wars you don’t often hear about - soldiers who die of self-inflicted wounds. Little is known about the true scope of suicides among those who have served in the military.
But a five-month CBS News investigation discovered data that shows a startling rate of suicide, what some call a hidden epidemic
So reads the lede from the CBS News website version of a CBS Evening News story aired last night.
I was anxiously awaiting this story because on the Veterans Day holiday (nice touch) a CBS News publicist fired this off to selected bloggers:
We are breaking a huge military story tomorrow and I wanted to give you a heads up and even see if you wanted to write something about it on your blog, I would be happy to help with information, graphics and more.
Below are the stories and a quote I got from Armen Kateyian - our chief investigative correspondent - for your blog. Please let me know if I can be of any more help.
So, what have these five-months produced?
Were I an operations researcher professor critiquing this I would have two comments. First, the plural of anecdote is not data. Second, post hoc ergo propter hoc is not an analytical technique.
I hope we can all stipulate up front that suicide is a tragedy for all, but especially those left behind. They are left with the lingering and unresolved questions of whether there were warning signs they should have caught, whether there was something they could have done. The cases highlighted by CBS News are otherwise healthy young men, and gender is an important part of the equation, who had served in the military and in Iraq.
But the issue raised by CBS News is not one of individual tragedy but rather two distinctly different theses. First, that veterans, particularly those who have served in Iraq and Afghanistan, have unusually high suicide rates. Secondly, and we'll have to see that part tonight according to the promo, a hapless Department of Veterans' Affairs is doing jack in response to this onrushing locomotive, in fact, they don't even know about it.
A bit of background here.
Veteran status has been part of the standard death certificate since 1939. The National Vital Statistics System, however, is a terribly decentralized system in which the states voluntarily paricipate. The federal government is a subscriber to that data and pays for it on a per record basis through grant agreements with the states. That data element, veteran status, has never been collated at the federal level. So while the data exists on an existential level it might as well not exist in any practical sense.
So kudos to CBS for collecting data sets from 45 states going back to 1995. This represents some 20 million plus entries and it had to have been fun compiling the database for analysis.
We don't know much about how they went about doing this so from this point on we're going to take a leap of faith and presume that their analysis of the veteran suicide rate is correct.
In 2005, for example, in just those 45 states, there were at least 6,256 suicides among those who served in the armed forces. That’s 120 each and every week, in just one year.
Dr. Steve Rathburn is the acting head of the biostatistics department at the University of Georgia. CBS News asked him to run a detailed analysis of the raw numbers that we obtained from state authorities for 2004 and 2005.
It found that veterans were more than twice as likely to commit suicide in 2005 than non-vets. (Veterans committed suicide at the rate of between 18.7 to 20.8 per 100,000, compared to other Americans, who did so at the rate of 8.9 per 100,000.)
One age group stood out. Veterans aged 20 through 24, those who have served during the war on terror. They had the highest suicide rate among all veterans, estimated between two and four times higher than civilians the same age. (The suicide rate for non-veterans is 8.3 per 100,000, while the rate for veterans was found to be between 22.9 and 31.9 per 100,000.)
National data for 2005 has not been published at this writing but data for 2004 and earlier is easily available through two public use databases managed by the Centers for Disease Control and Prevetion's National Center for Injury Prevention and Control. (here | here).
It is also worth noting that veteran status does not imply service in a combat zone and any attempted linkage of this annotation on a death certificate and actual combat duty is impossible.
Before moving into the issue of veterans let's take a side trip to active duty suicides. If service in Iraq and Afghanistan are contributing factors then one might expect the unique nexus of stress, imminent danger, family separation, and access to a veritable smorgasbord of deadly devices one finds in Iraq and Afghanistan would produce a higher than normal level of suicides. According to Department of Defense:
The Army Suicide Event Report, which tracks suicide attempts and completions and the factors involved, showed that in 2006 there were 99 suicides within the Army, 30 of which occurred in Iraq or Afghanistan. This is an increase from 87 suicides in 2005 and 67 in 2004.
According to the report, the Army’s suicide rate for 2006 was 17.3 suicides per 100,000 soldiers. This compares to the overall U.S. population rate, for the same age and gender group, of roughly 19 suicides per 100,000 people.
Suicide rates in other services aren't as easy to find but I think we could make a completely valid assumption that Army rates more than likely represent a ceiling to the active duty suicide rate rather than either a floor or a midpoint.
A key point to remember here, which this pull quote hits, is that the veteran population in not comparable to the civilian population of the same age. The active military population is about 85% male, the veteran population, reflecting the manpower policies of less enlightened times is a significantly higher percentage male.
I spent some time trying to duplicate the "other Americans" suicide rate variously given as 8.3 and 8.9 per 100,000 with limited success. It appears that number is derived from capping the age group at age 24 and extending it downward. If we look at standard age breaks, this is what we get as rates per 100,000 for all races and ethnicities and both (or however many we're recognizing these days) sexes in 2004:
15-19 years, 8.2; 20-24 years, 12.4; 25-34 years, 12.6; 35-44 years, 15.0; 45-54 years, 16.5; 55-64 years, 13.8; 65-74 years, 12.3; 75-84 years, 16.3; and 85+ years, 16.4.
So, at first blush, we compare the CBS story's figure of "between 18.7 and 20.8 per 100,000" and we get a significantly higher figure. But we know that the veteran population is overwhelmingly male. If we run the age cohorts as male only we get a different picture:
15-19 years,12.6; 20-24 years, 20.8; 25-34 years, 20.3; 35-44 years, 23.0; 45-54 years, 24.7; 55-64 years, 22.0; 65-74 years, 22.5; 75-84 years, 34.8; and 85+ years, 45.0.
Lo and behold, 20;8 per 100,000 is the exact same number as the rate of 20-24 year old males regardless of veteran status.
If we run it again as white males because the military is majority white (58% across all services and components with wild variations among occuapational specialties) and male (about 85%):
15-19 years, 13.5; 20-24 years, 22.0; 25-34 years, 21.7; 35-44 years, 25.6; 45-54 years, 27.5; 55-64 years, 23.9; 65-74 years, 24.1; 75-84 years, 37.0; and 85+ years, 48.3.
It would seem, that once the suicide rate is adjusted to reflect the demographics of the veterans population that the sucide rate among 20-24 year olds is statistically indistinguishable from that of the general population.
The story could end there but singular data points are rarely useful in analysis. One could argue that as suicides among 20-24 year olds in 2004 only totaled 2,607 then an "epidemic" of suicides among veterans in that age group could easily have skewed the data for males and white males making the veterans suicide rate look the same as the non-veteran rate of the same population.
If I am correct, then the suicide rate among the 20-24 year old male cohort, which I am using as a proxy for veterans, should remain similar over time. If CBS is correct, there should be a rise in that rate in 2004. If we go back about 30 years this is what we see:
1979 -- 26.5
1980 -- 26.8
1981 -- 25.7
1982 -- 25.2
1983 -- 24.0
Going forward ten years:
1993 -- 26.5
1994 -- 28.0
1995 -- 27.0
And since the Long War began:
2002 -- 20.8
2003 -- 20.2
2004 -- 20.8
Statistically, the suicide rate for this age cohort has remained unchanged since at least 1999.
None of this should be interpreted as saying some veterans have not committed suicide because of their experience when serving in Iraq and Afghanistan, or that more should not be done to provide mental health services to veterans but the CBS story does not contribute to the discussion.
The data they use are necessarily incomplete and their analysis flawed in concept and myopic in scope.
Of course they only had 5 months to do it in.