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FCW : February 2015
Analytics on those deaths is used by military officials to try to make the next sui- cide less likely. The data includes medical history, military history (such as demotions, disciplinary cases and deployments) and demographic data. The report also covers contextual details such as where and in what environment the suicide took place. The IG analyzed the 287 suicide cases reported through the database in 2011, the most recent annual data available at the time, and found that nearly a quarter of them had answers marked “don’t know” or “data unavail- able” in 50 percent to 100 percent of the data fields. The most common fields marked unknown or unavailable were whether the deceased was a victim of emotion- al abuse (missing 61 percent of the time), whether he or she had visited chaplain services (57 percent) and whether the deceased had a family history of mental illness (57 percent). It is important to note, however, that the IG study did not include the 2012 DODSER annual report, which was released on April 25. An appendix to the IG report notes “several areas of marked improvement” in DODSER data collection in 2012. The rate of “unknown” or “unavailable” answers to question of emotional abuse, for example, dropped from 61 percent to 35 percent. Nonetheless, the 2012 report shows a significant degree of incomplete DODSER data. The IG’s report notes that one reason for the missing infor- mation in 2011 is that many of the DODSER questions had medical jar- gon that only an expert could answer. If reports are incomplete or inacces- sible to some, officials are working with an incomplete picture in devising mental health policies. Picking up missing data pieces The database is managed by the National Center for Telehealth and Technology (known as T2), a DOD organization charged with applying technology to mental health problems. T2’s fiscal 2015 budget for managing the DODSER database and generating an annual report from it is $500,000, which does not include the military services’ budgets for using the data- base. There are two parts to the training an officer receives to learn how to fill out a DODSER. The first is an online evaluation, and the second is the spe- cific DODSER training administered by each of the military services, said T2 Deputy Director Mark Reger, who leads the DODSER program. He said user training for DODSER is adequate, but no one is going to be an expert in every aspect of what DODSER requires. For example, a military commander might know a soldier’s deployment history but not his medical diagnosis. The IG report recommends that DOD take a more multidisciplinary approach to reporting suicides, with each suicide triggering a local review board made up of unit leaders, medi- cal professionals and military inves- tigators. That approach would help deliver more complete and accurate data to the DODSER database, the IG said. Rajeev Ramchand, a senior behav- ioral and social scientist at Rand Corp. who studies suicide-prevention strate- gies for service members, offered an additional remedy to the problem of inexpert DODSER users. He called for a team of trained data experts at DOD to handle the data input for every case of suicide rather than rely- ing on a wide range of officers who might have very little experience with the database. “Are we looking for somebody who’s an expert in every single field or are we looking for somebody who’s an expert in collecting the data?” Ram- chand asked. “I would always go with someone who is [an expert in] collect- ing the data.” Ramchand said the DODSER data- base is an effective and comprehen- sive means of tracking military sui- cides and suicide attempts but pointed out what he said is a blemish: The input fields do not leave much room to explain the source of the informa- tion. For example, if an entry notes that a soldier had trouble in a roman- tic relationship, it might simply cite the commander as the source of that information. Ramchand said limited information in that case might misidentify a con- tributing factor to suicide. “The point of surveillance is to identify trends so that we can intervene, and we need to make sure that we’re intervening on the right things,” he said. Although DODSER matches up closely with many of the Centers for Disease Control and Prevention’s rec- ommendations for compiling suicide data, one area where it does not is in detailing the source of the informa- tion, Ramchand added. The hunt for better data is not likely to ever be fully satisfied, but the previ- ous approach puts things in perspec- tive. Before the DODSER database began to offer a standard method of suicide surveillance in 2008, the mili- tary services “each had their own [sys- tems] for analyzing and understand- ing the characteristics and nature of suicide in their service,” Reger said. DODSER offers a more complete picture of suicide across the services, one that DOD is trying to combine with data provided by VA. The promise of data sharing Reports from military bases around the world are one piece of suicide- prevention policy. Another is sharing that data with VA as soldiers retire and become veterans. To that end, the two agencies set up a joint Sui- cide Data Repository (SDR) in fiscal 24 February 2015 FCW.COM 0215fcw_023-026.indd 24 1/27/15 9:36 AM
March 15, 2015