Suicide and Protective Service Occupations: Findings from a Nationally Representative Sample

Background and Purpose: Suicide remains a significant public health concern as one of the top ten causes of death in the United States. Research has identified determinants in suicide rates by gender, age, race/ethnicity, education/income, marital status and mental health. However, social work research can extend the knowledge associated with suicidality by examining additional social determinants of suicide, including client occupation. Occupations such as protective service workers are at heightened risk for increased substance abuse and mental health issues due to repeated exposure to stress and trauma. However, it is unclear whether the risks associated with protective services occupations heighten risk for suicide. The purpose of this study is to explore whether protective service occupations have an increased likelihood for suicidality, controlling for additional factors associated with suicide.  

Methods: Data is from the combined 2011 and 2012 National Survey of Drug use and Health (NSDUH), an annual nationally representative survey administered by SAMHSA. The total sample from the 2011 and 2012 NSDUH was 113,665. Participants reported social demographics including age, race/ethnicity, gender, education, marital status and annual household income, and clinical variables, including past year DSM-IV diagnoses of major depressive disorder, alcohol use disorder, and drug use disorder. Participants were asked three dichotomous questions associated with suicidal ideation in the past year: whether they had thought about suicide, made a plan, or attempted suicide. Finally, participants were asked to report their current occupation, which was dichotomized to identify protective service worker status. Protective service workers include correctional officers, police officers, fire fighters and other law enforcement personnel. A multivariate logistic regression analysis examined whether protective service workers were significantly more likely to report suicidal ideation, controlling for social and clinical variables associated with suicide risk. All analyses used population weights provided within the NSDUH to adjust for nonresponse and geographic distribution of the sample.

Results: Among respondents, 2.8% of protective service workers reported they had thought about suicide in the past, 0.9% had made a plan to commit suicide, and 0.1% had attempted suicide in the past year. Compared to other occupations, protective service workers were more likely to be male, possess higher levels of education, higher income, less likely to have a past-year drug use disorder, and less likely to seek treatment for mental health related problems. While multiple correlates of suicidal ideation emerged, logistic regression models showed that while protective service workers were no more likely to have thought about suicide, or made a plan, protective service workers were significantly more likely to have attempted suicide in the past year (OR = 2.74), compared to other occupations.

Conclusions and Implications: Current evidence-based interventions in reducing suicidal ideation focus on brief, rapid assessment, information exchange, education, and long-term, regular follow-up contact across all points of access for health care facilities. A significantly higher likelihood of suicide attempt among protective service workers requires improved delivery of these interventions from social workers, emphasizing stronger integration within occupation based settings, among individuals in protective service occupations.