Suicide and suicidality surveillance in military populations: a scoping review

Abstract

Background: Suicide and suicidality are a serious public health concern for military populations globally. Systematic surveillance is a key component to creating an evidence base for prevention strategies. The aim of this scoping review is to map how suicide and suicidality is surveilled in military populations, and to summarize key inclusions, limitations and gaps.

Methods: A scoping review of four databases (PubMed, PsychInfo, ProQuest and CINAHL) and a targeted grey literature search of official military websites using Google was conducted using variations of the search terms 'Suicidality,' 'Military' and 'Surveillance'. Sources that referenced systematic, population-level data collection on suicide and/or suicidality in active duty military personnel, written in English with any publication date, were considered. Sources that used veteran and part-time personnel data were excluded, as were sources that focused exclusively on subsets of the population such as one job role or one overseas deployment rotation. Descriptive analysis was conducted, comparing sources across surveillance type, data collection and usages, and limitations and author recommendations.

Results: Twenty-six articles were identified by the search criteria. Most sources were from the USA (n = 14), and publication dates ranged from 1968 to 2023. The most common surveillance systems were military mortality databases focused on death by suicide. Ideation, non-suicidal self-injury and suicide attempts were under-surveilled, as were event and outcome characteristics. Best-practice guidelines were unable to be determined due to the heterogeneity of systems and paucity of published details.

Conclusion: This study was the first scoping review to map the application of surveillance systems specifically in military populations. We identified an over-reliance on mortality databases, a paucity of surveillance of non-fatal suicidality and opportunities for improvement including enhanced data collection and the integration of lived experience perspectives. The findings of this review contribute new knowledge to the field and have important research and practical implications.

Keywords: military; suicidality; suicide; surveillance.

Figure 1

PRISMA diagram of literature search strategy and results.

Figure 2

Heat map displaying the surveillance system characteristics reported in each reference.