Suicide behavior among heterosexual, lesbian/gay, and bisexual active component service members in the U.S. Armed Forces.

Lesbian, gay, and bisexual (LGB) individuals are at a particularly high risk for suicidal behavior in the general population of the United States. This study aims to determine if there are differences in the frequency of lifetime suicide ideation and suicide attempts between heterosexual, lesbian/gay, and bisexual service members in the active component of the U.S. Armed Forces. Self-reported data from the 2015 Department of Defense Health-Related Behaviors Survey were used in the analysis. Multivariable logistic regression demonstrated that lesbian/gay and bisexual service members were more likely to report past suicide ideation when compared to heterosexual service members (adjusted odds ratio [AOR] for lesbian/gay: 1.79; 95% CI:1.14-2.82; AOR for bisexual: 2.33; 95% CI: 1.56-3.49). Similar results were observed for past suicide attempt for lesbian/gay (AOR: 2.29; 95% CI: 1.15-4.57) and bisexual SMs (AOR: 2.04; 95% CI: 1.24-3.38). Despite disparities in suicide ideation and attempt by sexual orientation, a majority of service members' behavioral health questionnaires do not assess sexual orientation. Clinical screenings of suicide risk in military settings should factor in sexual orientation to more comprehensively assess association between sexual orientation and suicidal behavior in this population.

A Cross-Sectional Examination of the Association Between Social Media Use and Sleep Among a Sample of U.S. Army Soldiers.

INTRODUCTION: In the United States (U.S.), approximately 35% of adults sleep less than 7 hours per night. The relationship between social media use and insufficient sleep has not thoroughly been examined among adults. The purpose of this study was to determine if social media use is associated with insufficient sleep among a sample of U.S. Army Soldiers. METHODS: This study surveyed 9,052 U.S. Soldiers in 2018 via a self-administered online questionnaire. Using multivariable logistic regression, we examined the association between social media use (<38 hours vs. ≥38 hours per week) and insufficient sleep, controlling for demographic and behavioral covariates. RESULTS: Overall, 54.9% of Soldiers reported insufficient sleep. There was no significant relationship between excessive social media use and insufficient sleep in the multivariable logistic regression (OR: 1.03; CI: 0.87-1.23). The covariates of sex, race/ethnicity, rank, hazardous alcohol consumption, anxiety, and depression were significantly associated with insufficient sleep. Soldiers who reported symptoms of anxiety were more than twice as likely (OR: 2.11; CI: 1.65-2.70) to report insufficient sleep than Soldiers without signs of anxiety. Additionally, Soldiers who reported depressive symptoms were 85% (OR: 1.85; CI: 1.44-2.37) more likely to experience insufficient sleep than Soldiers without signs of depression. CONCLUSION: Sufficient sleep is essential to ensuring mission readiness and preventing accidental morbidity and mortality among Soldiers. The findings of this analysis do not suggest a link between extended social media use and insufficient sleep. However, though previously uninvestigated, Soldiers reporting symptoms of anxiety and depression were more likely to experience insufficient sleep compared to unafflicted Soldiers. Therefore developing a culture that encourages Soldiers to seek necessary behavioral health screening and care could be a key primary strategy to promote adequate sleep.

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

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.

Mortality surveillance in the U.S. Army, 2005-2011.

PURPOSE: Mortality rates in the U.S. Army from 2005 to 2011 were examined over time and compared to the U.S. general population. METHOD: Cases were U.S. Army Soldiers (active duty or activated National Guard/Reserve) with dates of death between 2005 and 2011 and between 18 and 64 years of age in the Department of Defense Medical Mortality Registry. Age- and sex-adjusted annual mortality rates (AR) were calculated for each category of death and examined via linear regression. Proportions of underlying causes of death were also examined. RESULTS: The trend in AR in the U.S. Army significantly decreased for combat deaths, the average annual percent change (AAPC) = 15.2% decrease in the log of the rate (LAR); p = 0.04 and accident deaths, AAPC = 5.4% decrease in the LAR; p = 0.002 and significantly increased for suicides, AAPC = 10.6% increase in the LAR; p = 0.001. The trend in AR for suicides for the Army was significantly different compared to the U.S. general population, AAPC = 11.0% increase in the LAR; p < 0.001. CONCLUSIONS: Trends in rates of combat deaths and accident deaths declined although rates of suicides increased. The Army suicide rate increased in comparison to the United States. 70% of accident deaths were transportation related. Almost 70% of suicides and homicides were firearm related.

Performance excellence: using Lean Six Sigma tools to improve the US Army behavioral health surveillance process, boost team morale, and maximize value to customers and stakeholders.

Lean Six Sigma (LSS) is a process improvement, problem-solving methodology used in business and manufacturing to improve the speed, quality, and cost of products. LSS can also be used to improve knowledge-based products integral to public health surveillance. An LSS project by the Behavioral Social Health Outcomes Program of the Army Institute of Public Health reduced the number of labor hours spent producing the routine surveillance of suicidal behavior publication. At baseline, the total number of labor hours was 448; after project completion, total labor hours were 199. Based on customer feedback, publication production was reduced from quarterly to annually. Process improvements enhanced group morale and established best practices in the form of standard operating procedures and business rules to ensure solutions are sustained. LSS project participation also fostered a change in the conceptualization of tasks and projects. These results demonstrate that LSS can be used to inform the public health process and should be considered a viable method of improving knowledge-based products and processes.