Leo Sher
Columbia University and New York State Psychiatric Institute, New York, New York, USA
Suicide in the Military. Hauppauge, New York: Nova Science Publishers, 2009, 210 pages.

Suicide in the military has been recognized as an important problem many years ago. The ideal method of protection against suicide is primary prevention, i.e. reduction of number of new cases. The goal of secondary prevention is to decrease the likelihood of a suicide attempt in the high-risk individuals. Clinicians, especially in the military should regularly inquire about current depression, hopelessness, and suicidal ideation. Tertiary prevention is aimed at diminishing the consequences of suicide attempts. Tertiary interventions include the assessment of family members, close friends or fellow soldiers who may be influenced by the suicide attempt to attempt suicide themselves.
Prevention of mental disorders can be divided into three categories: universal preventive interventions, selective preventive interventions, and indicated preventive interventions. Suicide prevention efforts can also classified as either universal, selective, or indicated. A universal approach is designed for everyone in a defined population regardless of their risk for suicide, such as a health care system, or a county, or a school district, or a military unit. A selective approach is for subgroups at increased risk, for example, due to age, gender, ethnicity or family history of suicide. This may be especially important in the military because a family history of suicidal behavior does not preclude someone from joining the military. An indicated approach is designed for individuals who, on examination, have a risk factor or condition that puts them at very high risk, for example, a recent suicide attempt.
There are some specific problems arising in the military surrounding. A military unit is a closed system that may restrict personal freedoms. Many servicemen loose significant relationships and have financial and psychological problems. Firearms as a means of suicide are available in the military. A combination of psychosocial problems with availability of firearms contributes to incidents of suicide in the military.
The prediction of suicidal behavior is based on inexact criteria that are relatively poor at predicting the behavior of a given individual. However, this is a very important task in the military taking into account that military people usually have access to firearms. The prediction and prevention of suicide in the military remain a major challenge and need further studies.