Suicide Following Medical/Physical Evaluation Boards: A Complication Unique to Military Psychiatry

Abstract

Psychiatrically hospitalized military members are at risk for suicide during Medical/Physical Evaluation Board processing. Following initial hospitalization and treatment, usually for major depression, members are entered into medical administrative channels. During this period they are often returned to duty, placed on "casual" status in a holding company, or moved to a "transition unit" within the hospital, often under the care of other than mental health personnel. It is in this situation that they must face the reality of the loss of their military identity and career. This stressor may occasion a reoccurrence of the presenting illness which may be missed by medical personnel because the member is viewed by them as treated, or no longer actually a patient, but rather in the process of leaving. Medical personnel are reminded that ongoing or de novo psychiatric illness, including the risk of suicide, can and does occur on the occasion of separation from the military as stressor-independent from the reason for admission.

Suicide Among Regular-Duty Military Personnel: A Retrospective Case-Control Study of Occupation-Specific Risk Factors for Workplace Suicide

“…Our bivariate analysis, echoing data from other studies, highlights the contribution to military suicide of psychiatric indicators and psychiatric illness (7,41,42), particularly alcohol misuse problems (43). The temporal association between suicide and prodromal signs of mental illness (44), relationship difficulties (mostly marital/ sexual), civilian legal actions (5,12,45), feared medical boarding (discharge) (46), and recent reprimand or punishment were also important. In the Irish forces, as in many others, personnel are referred to psychiatrists by medical officers, not by commanding officers.…”

Are UN Peacekeepers at Risk for Suicide?

“…Prevention of suicide in the military is impeded by the “macho” soldier culture, which deters a soldier from admitting emotional difficulty, perceiving it as weakness. Soldiers also know that applicants with a known history of psychiatric illness are excluded from recruitment and released from service earlier (Fragala & McCaughey, 1991). Consequently, psychiatric and social difficulties may be concealed from helping agencies within the services.…”

Suicide prevention in military organizations

“…Those in the US Army and Marine Corps and those in security and combat arms trades (Helmkamp, 1996) have been noted to have an increased risk. Common military suicide triggers include failed intimate relationships, fi nancial problems, legal/disciplinary problems, work stress, and imposition of medical employment limitations (Army Suicide Prevention Task Force, 2010; Fragala & McCaughey, 1991;Hawton et al ., 2009).…”