Suicide is alas a common problem for doctors, and the rate is higher in certain groups, such as those suffering from post traumatic stress syndrome, drug or alcohol abuse, those with access to lethal weapons and drugs, and men.

You see, men have a much higher suicide rate than women.

By Gender

Sex number of suicides population rate

Males 25,566 144 million   Suicide rate: 17.7

————————————————————————————–

Females 6,873 149 milllion Suicide rate:   4.6

———————————————————————————-

Total 32,439 293 million Suicide rate: 11.1
Figures from the National Center for Health Statistics for the year 2004.
All rates are per 100,000 population.

Figures from the National Center for Health Statistics for the year 2004.
All rates are per 100,000 population

Male suicide rate is 17.7…women is 4.6…and so the “suicide rate” of Americans is 11.1.

Each of these statistics is a sorrowful event for those involved and for their families, especially since many of these deaths can be prevented by intervention and treatment.

But CBS NEWS is now using an “expose” on suicides in veterans to “expose” the problem, and to prove their point, they are using dubious statistical data and comparing apples to oranges to exaggerate the problem.

Ralph Peters is right: the news from Iraq is bad, so it will be ignored, while the press either reports on O.J. or will have to make up stories to find news that is bad to ignore the improving reality on the ground.

So the CBS report on suicide in veterans starts with an anecdote, and then tells us:

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.)

Ummm…go to the first table.

Notice the difference between men and women?

The suicide rate of men of all ages is 17.7 per 100 000 population because men tend to shoot themselves or use other “lethal” methods.
And also note: the rate in women is much lower: 4.6. Women tend to try to kill themselves more often than men, but often use less lethal means of suicide. Part of this is because women don’t have access to guns, which tend to be more efficient than pills in suicide, and partly because often women attempt suicide as a cry for help and are found before they die.

There is a problem of suicide in veterans, as would be expected, which is why the military has suicide prevention programs, and why President Bush signed bill HR 327 to increase mental health training for VA personnel.

Nor is the problem of suicide ignored by the military: indeed, the suicide intervention/prevention program in the US Air Force has been credited with lowering the rate of suicide in that service from 16 per 100 000 population to 9/ 100 000. Indeed, this program has been suggested as a model to try to lower the very high rate of suicide among physicians.

So the problem of suicide among veterans is not exactly a new problem, nor is it a problem that is not being addressed.

Yet if one reads this article by CBS news, one will not find any of these basic facts.

And the reason for the producers ignoring these facts may be found in this sentence:

But a five-month CBS News investigation discovered data that shows a startling rate of suicide, what some call a hidden epidemic, Chief Investigative Reporter Armen Keteyian reports exclusively.

Translation: The investigator did the investigation to expose the epidemic of suicide. The reporter started with a template: Bush lied, veterans died, and then easily went out to find anecdotal cases of suicide. Fair enough.

But when the report states this, we know that the reporters are deliberately biasing statistics to prove their thesis:

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.)

What’s wrong with this picture?

Well, to begin with, the first number, a suicide rate in veterans from 18 to 20, is not much higher than the rate for all American men. So their claim that the veterans suicide rates is “Twice as high” is false, since they are comparing the rate of suicide of mainly young men with the suicide rate of men and women—and women have a significantly lower suicide rate of men.

The second problem is that they extrapolated a limited population to assume that it represented the general population.
The reason this is important is that if the “veteran” spent three years in Germany in 1958, it may not prove anything about veterans who served in combat.

The second reason is that “veterans” include many elderly who served in World War II and Korea…and the rate of suicide in men over the age of 70 jumps to 30.

The suicide rates tend to go up with age.

TABLE 1. Rate * of suicide for persons aged >=65 years and percentage change from 1980 to 1992,
by age group and race -- United States
==================================================================================================
Men                       Women                      Total
Age group  -----------------------    ----------------------   -------------------------
(yrs)     1980   1992   % Change    1980   1992   % Change    1980   1992   % Change
--------------------------------------------------------------------------------------------------
65-69      28.0   27.4     - 2.1      6.6    6.0     - 9.1     16.1   15.6    - 3.1
70-74      33.3   33.0     - 0.9      6.4    5.8     - 9.4     17.7   17.5    - 1.1
75-79      41.1   45.2     +10.0      5.9    6.1     + 3.4     19.5   21.6    +10.8
80-84      43.5   58.6     +34.7      4.7    6.4     +36.2     18.2   24.6    +35.2
>=85      50.1   62.6     +25.0      5.4    6.0     +11.1     19.0   21.9    +15.3

Total      34.8   38.4     +10.3      6.0    6.0     - 0.7     17.6   19.1    + 8.5
--------------------------------------------------------------------------------------------------
* Per 100,000 pouplation, rounded to tenths.
==================================================================================================

The final figure is that of veterans who served in combat aged 20-24, who had a much higher rate of suicide than the population (22-31 are the figures estimated by CBS). Suicide rates among young men aged 16-25 are about 16, aged 25-35 are 19. So that number is much higher, about twice as many as expected.

But I am puzzled about the cut of of their figures: Aged 20-24. In Viet Nam, the average draftee was 19. But what is the average age of those serving in Iraq or Afghanistan, where many who serve are members of the National Guard and tend to be older men and women. By limiting the data to young people, were the numbers so low that statistics would not be accurate?
The high numbers in the lower age group could be attributed to younger people who do not handle stress as well, or that younger people tend to be in combat situations more than the National Guard. Without full statistics we just don’t know. But I am puzzled that the CBS producers don’t use returning combat veterans of all ages. Indeed, by limiting the statistics to a few states and a small age group, there is always the possibility of statistical error. But we don’t know, because we aren’t given the hard data to analyze the statistics.

So I will agree: If true the suicide rate of young men who served in combat is much too high and something needs to be done about it.

Indeed, it is about the same as a man over the age of 65, whose rate is 27. And we need to do something about that, too.
We need intervention, such as funded by the bill that Bush signed last week.

And while we’re at it, maybe we need a bill to fund ways to decrease the suicide rate among physicians, which is between 28 and 40…higher than that of returning young veterans.

Suicide

The overall physician suicide rate cited by most studies has been between 28 and 40 per 100,000, compared with the overall rate in the general population of 12.3 per 100,000.[1] Overall, then, physicians are more than twice as likely as the general population to kill themselves. Each year, it would take the equivalent of 1 to 2 average-sized graduating classes of medical school to replace the number of physicians who kill themselves. This rate appears higher than among other professionals.[2]

So while we’re at it, how about money to stop docs from commiting suicide? After all, OUR rate is higher than young, immature combat veterans aged 20-25…

—————

Nancy Reyes is a retired physician  living in the rural Philippines. She writes medical essays on Hey Doc Xanga Blog.

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