Means and capacity for suicidal behavior: A comparison of the ratio of suicide attempts and deaths by suicide in the US military and general population

Background: There is a discrepancy in the frequency of non-lethal and lethal suicidal behavior. Given the extensive training in firearms within the military and prior research indicating that military personnel exhibit elevated mean levels of the acquired capability, we hypothesized that the ratio between non-lethal and lethal suicidal behavior would be lower in US military personnel than in the general population. Method: We examined publicly available data on non-lethal and lethal suicidal behavior within the US military and US general population. Results: The ratio of non-lethal to lethal suicidal behavior was lower in military across sex and age. Furthermore, results indicated that a greater proportion of both non-lethal and lethal suicide attempts in military personnel involved firearms. When considering only suicidal behavior unrelated to firearms, the ratio remained significantly lower in the military. The ratio of non-lethal to lethal suicidal behavior involving drugs and alcohol was not significantly lower in the military. Limitations: The use of public data precluded analyses directly testing competing theories. Also, level of intent involved in non-lethal self-injury in the general population was unclear. Finally, only active duty personnel were considered in analyses related to the military. Conclusions: Suicide attempts in the military are more likely to result in death than in the general population. This appears to be primarily due to the use more lethal means. Clinically, this speaks to the importance of recognizing suicidal desire in military personnel, as it is more likely to be paired with the capacity for suicide than in civilians. (C) 2012 Elsevier BY. All rights reserved.