Suicide Risk Factors in US Soldiers Identified

Liam Davenport

July 13, 2015

Enlisted soldiers in the US Army have a far higher risk for suicide than officers, researchers have discovered in findings that point to potential risk-factor-based suicide prevention strategies.

Robert J. Ursano, MD, Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland, and colleagues found that the factors associated with suicide differed between enlisted soldiers and officers, although female sex, age when entering service, and a recent mental health diagnosis were important predictors in both populations.

"Enlisted soldiers in their first tour of duty account for most medically documented suicide attempts. Risk is particularly high among soldiers with a recent mental health diagnosis," the investigators note.

"A concentration of risk strategy that incorporates factors such as sex, rank, age, length of service, deployment status, and mental health diagnosis into targeted prevention programs may have the greatest effect on population health within the US Army," they add.

The study was published online July 8 in JAMA Psychiatry.

The researchers examined data from the Army Study to Assess Risk and Resilience in Servicemembers (STARRS) on 9791 suicide attempts between January 1, 2004, and December 31, 2009, among active-duty regular Army soldiers.

They used individual-level person-month records from Army and Department of Defense administrative records to determine sociodemographic, service-related, and mental health predictors of medically documented suicide attempts in comparison with an equal-probability sample of 183,826 control person–months.

The results showed that 98.6% of all suicide attempts were among enlisted soldiers, at an overall rate of 377.0 per 100,000 person-years, although they accounted for only 83.5% of active-duty soldiers.

Commissioned officers and warrant officers formed 16.5% of the regular army but accounted for only 1.4% of suicide attempts, at an overall rate of 27.9 per 100,000 person-years.

On multivariate analysis, predictors of suicide attempts among enlisted soldiers were as follows:

  • female sex (odds ratio [OR], 2.4);

  • entering service at age 25 years or younger (OR, 1.6);

  • current age 29 years or younger (OR 5.6 for age <21 years, 2.9 for age 21 - 24 years, and 1.6 for age 25 - 29 years);

  • white race (OR, 0.7 for soldiers of black, Hispanic, or Asian ethnicity vs white combatants);

  • having less than a high school education (OR, 2.0);

  • being in the first 4 years of service (OR, 2.4 for 1 - 2 years, and 1.5 for 3 - 4 years);

  • having never or previously been deployed (OR, 2.8 and 2.6, respectively); and

  • being diagnosed with a mental health condition during the previous month (OR, 18.2).

Predictors of suicide among officers were female sex (OR, 2.8), entering service at age 25 years or older (OR, 2.0), being currently aged 40 years or older (OR, 0.5), and being diagnosed with a mental health condiotion during the previous month (OR, 90.2).

Further analysis indicated that, on discrete-time hazard models, the risk for suicide among enlisted soldiers was highest in the second month of service (102.7 per 100 000 person-months) and declined with increasing length of service, to a mean of 56.0 per 100,000 person-years during the second year of service and 29.4 per 100,000 person-months after 4 years of service.

The risk for suicide among officers remained stable over time, at an overall mean of 6.1 per 100,000 person-months.

"The findings suggest that enlisted soldiers and officers require unique considerations in research and prevention," the researchers write.

"Beyond potentially important differences in sociodemographic characteristics (eg, higher educational levels among officers), training, and occupational responsibilities, these groups also have distinct risk distributions," they add.

Discussing the application of their findings, the researchers say: "For clinicians assessing individual risk, distinguishing between who they are likely to see in practice vs who is at highest risk in the population is important."

"Similarly, program planners seeking to have the greatest effect on population health must consider where risk is concentrated within the population when developing interventions."

Army STARRS was sponsored by the US Department of the Army and funded by cooperative agreement U01MH087981 with the US Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health. Dr Kessler has been a consultant during the past 3 years for J & J Wellness & Prevention, Inc, Lake Nona Institute, Ortho-McNeil Janssen Scientific Affairs, Sanofi, Shire US Inc, and Transcept Pharmaceuticals Inc; has received research support for his epidemiologic studies during this period from EPI-Q, Sanofi, and Walgreens Co; and owns a 25% share in DataStat, Inc. Dr Stein has been a consultant for Healthcare Management Technologies, Janssen Pharmaceuticals, Pfizer, and Tonix Pharmaceuticals. The other authors have disclosed no relevant financial relationships.

JAMA Psychiatry. Published online July 8, 2015. Full text

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