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. 2018 Jun;108(6):769-776.
doi: 10.2105/AJPH.2018.304410. Epub 2018 Apr 19.

Adjusting Suicide Rates in a Military Population: Methods to Determine the Appropriate Standard Population

Eren Youmans Watkins  1 , Anita Spiess  1 , Ihsan Abdul-Rahman  1 , Christopher Hill  1 , Nkechinyere Gibson  1 , Jerrica Nichols  1 , Vanessa McLeod  1 , Latoya Johnson  1 , Trevor Mitchell  1 , Joseph Anton Pecko  1 , Kenneth Cox  1
Affiliations

Adjusting Suicide Rates in a Military Population: Methods to Determine the Appropriate Standard Population

Eren Youmans Watkins et al. Am J Public Health. 2018 Jun.

Abstract

The choice of the standard population is important when calculating adjusted rates for a military population: results can influence policies and funding allocations for programs and initiatives for suicide prevention. We describe the methodological considerations and decision-making process used in choosing a standard population for adjusting rates to compare suicide among US Army soldiers and the general US population. We examined 5 different standard populations, using the direct method to adjust annual suicide rates for the Army and the US population, 2004 to 2015, for age and for age and sex. The pattern of the Army and US population age- and sex-adjusted rates remained consistent with crude rates when adjusted to any of the Army standard population distributions. Using an Army distribution as the standard population produces suicide rates consistent with routine messaging about suicide trends among Army soldiers.

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Figures

FIGURE 1—
FIGURE 1—
Direct Adjusted US Army Suicide Rates Using Different Standard Populations: 2004–2015
FIGURE 2—
FIGURE 2—
Direct Adjusted US Population Rates Using Different Standard Populations: 2004–2015 Note. The lines for rates adjusted to the 2000 US population are coincident, so the line adjusted for age only is not visible.
FIGURE 3—
FIGURE 3—
Decision Tree to Guide Scientists in Selecting Rates (Crude, Stratified, or Adjusted) and Standard Populations
See this image and copyright information in PMC

References

    1. Army Suicide Prevention Task Force. Army health promotion, risk reduction, suicide prevention: report 2010. Available at: http://www.armyg1.army.mil/hr/suicide/docs/Commanders%20Tool%20Kit/HPRRS.... Accessed February 7, 2018.
    1. Pruitt LD, Smolenski DJ, Bush NE, Skopp NA, Hoyt TV, Grady BJ. Department of Defense suicide event report: calendar year 2015 annual report. Report E-6A4ED71. 2016. Available at: http://t2health.dcoe.mil/sites/default/files/DoDSER_2015_Annual_Report.pdf. Accessed February 7, 2018.
    1. Nock MK, Deming CA, Fullerton CS et al. Suicide among soldiers: a review of psychosocial risk and protective factors. Psychiatry. 2013;76(2):97–125. - PMC - PubMed
    1. Surveillance of Suicidal Behavior, January—December 2011. Aberdeen Proving Ground, MD: Army Institute of Public Health; 2012.
    1. Gibson N, Corrigan E, Kateley K, Watkins EY, Pecko JA. Surveillance of Suicidal Behavior, January Through December 2016. Aberdeen Proving Ground, MD: Army Public Health Center; 2017. Public Health Report S.0008057–16.

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