Suicidal behaviour among women military personnel is higher than men (But let’s not talk about it!)

The Report of the 2016 Mental Health Expert Panel on Suicide Prevention in the Canadian Armed Forces has just been released. This is when a Panel of experts in Suicide Prevention gathered together to interpret data from various sources to review current practices and make recommendations regarding the Canadian Forces suicide prevention strategies.
​Here are some findings of their reports and findings from data these experts used for their Report...

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1. Women veterans deaths by suicide are higher than male veterans

A 2010 data linkage found that, compare to the general population, death by suicide was…

• 1.42 times higher for male Veterans (compare to the general male population).
• 2.5 times higher for female Veterans (compare to the general female population)

Source: Report of the 2016 Mental Health Expert Panel on Suicide Prevention in the Canadian Armed Forces

2. Over their lifetime, military women think, plan and attempt suicide more than military men

The 2016 Trends in suicidal behaviour and use of mental health services in Canadian military and civilian populations stated that ‘’when comparing military personnel only, women lifetime prevalence of suicidal ideation did decreased significantly over the 10-year period.’’ However, even after a significant decrease, the same table shows that the women suicidal ideation, plan and attempt are still much higher than the men:

• Suicidal ideation among women military personnel is still 23% higher (women 18.4% men 14.9%)
• Suicide plan among women military personnel is still 14% higher (women 6.7%, men 5.9%)
• Suicide attempts among women military personnel are still double (women 5.4%, men 2.6%)  

This 2016 review chose to ignore these stats listed on their own table A and B and reduce their conclusion to this: “Male military personnel had a significant increase in the lifetime prevalence of suicide attempts, and female military personnel had a significant decrease in the lifetime prevalence of suicidal ideation”.  

3. Over a year time-frame, military women think, plan and attempt suicide as much as men

​The table Past-year prevalence of suicidal behaviour among Canadian military personnel and civilians, 2002–2012/13 found in the 2016 Trends in suicidal behaviour and use of mental health services in Canadian military and civilian populations indicates that, in 2013, military suicidal ideation rates for men and women were virtually identical (4.3%).

4. Yet, despite all these previous data, the 2017 Suicide prevention in the Canadian Armed Forces paper chose to exclude military women from their research.

What was the reason given in the 2017 Suicide prevention in the Canadian Armed Forces to exclude military female stats from the suicide prevention report? “Regular Force female suicide numbers tend to be too small to be statistically analyzed with any degree of accuracy’’.
What was the reason given to not pay attention to the much higher rate of female suicide ideation, plan and attempts? “The number of reported attempts cannot be used as statistical rates of attempted suicide.”
​What was the reason given to not pay attention to the much higher rate of female veteran’s suicide? None. I am guessing they choose, conveniently, to only focus on the one element were men soldiers are at higher risk: suicide while serving in the CAF.

5. Of course, none of the research used by the Expert panel looked into Military Sexual trauma…

In fact, they looked at pretty much everything except military sexual trauma. Here is what the Expert panel was looked into:
Deployments, combat exposures, peacekeeping operations, stigma, child abuse, physical health, access to care, incarcerated veterans, resilience, household income, mental disorders, mental illness, psychiatric illness (borderline personality disorder, Narcissistic personality, Anxiety and depression, posttraumatic stress and obsessive-compulsive disorders), exposure to a suicide, regions with high suicide rates, first nations, school suicide prevention for youth, psychiatric hospitalization, substance abuse (opioid overdose, cocaine dependence), Families, late-life suicidality, work reintegration, mild traumatic brain injury, in-theater care prior to deployment, physical disorders, pharmacological treatments , self-confidence and easy access to weapons.
​Sceptical? Look at the 78 references  (they are listed in the last page of the Report).

6. Conclusions of the panel?

So after the Expert panel read that…

1. women veterans death by suicide is higher than male veterans
2. over their lifetime, military women think, plan and attempt suicide more than military men; and
3. over a year time-frame, military women think, plan and attempt suicide as much as men

They decided to list “male sex” as the second risk factor for suicidal behaviour among military personnel and veterans. Military Sexual Trauma and workplace harassment is, of course, not even mentioned once in their entire Report.

7. Recommendations of the Expert Panel?

In their Report Annex A: Questions to Consider when Conducting a Systematic Review of Canadian Armed Forces Suicides the Expert panel does not suggest to include gender consideration or ask questions about Military sexual trauma or workplace harassment in the future.
 
Never underestimate the power of denial.

​*On a positive note: Out of the 15 panel members, seven were women (good job diversity!).

Here are my findings!

In the absence of data on care for Military Sexual Trauma in the Canadian Armed Forces, I made some non-scientific inquiries of my own. I ask questions to 71 Survivors of Military Sexual Trauma from the CAF from my group. Here are the results...

• ONLY 7%​ of the respondents say they  got treated and were able to stay in the CAF and continue their career after reporting a Military sexual assault/harassment.

​Again, this is done with members of my group, it's not scientific, but it should give CFHS something to chew on and, maybe, entice them to start tracking the results of their own care...and publish it.

Here are my questions...

1. Are the CFHS focus and these medical reporting norms good enough for the CAF?
   
2. Are these types of medical reporting norms and focus helping our hurting Op Honour mission? ​

Here is my conclusion

The good new is that there are lessons to be learned from this Report. This Report would be a amazing case study in...let's say... a new mandate to review the CFHS focus and medical reporting norms and to dress a specific action plan on how to integrate GBA+ and Op Honour recruiting goals within the CFHS.​ Just food for thought here.
​Clearly more needs to be done to support specifically women's health issues and to help retaining women.

To avoid these ''Faux pas'' in the future, may I suggest the following?

1. Get an agenda adviser on board to monitor this type of research to ensure not gender biais gets in the way of real progress in care.
2. Have a patient advocate on such panels.
3. Build a strategy for a better gender responsiveness from the CFHS and don't expect Surgeon Generals to self regulate. Create some kind of accountability.