Under the Hood

Suicide Attempts Among US Army Soldiers More Likely Before Combat: Study

US Army
Never-deployed soldiers were at highest risk of a suicide attempt between 2004 and 2009 of the Iraq and Afghanistan conflicts. Reuters

Over the past decade, suicide attempts have increased in the United States Army. Despite the issue's urgency, little has been done to understand these failed attempts at self-destruction. New research from Uniformed Services University of the Health Sciences suggests enlisted soldiers never deployed to Iraq or Afghanistan were at greatest risk of a suicide attempt, particularly in their second month of service.

“The higher risk among ND soldiers in their second month of service, a stressful time during basic training and Army acculturation, reinforces the importance of developing and evaluating effective risk detection and intervention strategies early in a soldier’s career,” noted the researchers. “Whether this risk pattern was associated with expanded Army recruitment during war or anticipated deployments or is a persistent pattern of risk among soldiers in training remains to be determined.”

The team also discovered soldiers on their first deployment were most at risk for a suicide attempt during their sixth month of deployment, while previously deployed soldiers were most at risk five months after they returned from the warzone.

“Understanding how people go from health, to suicide ideation, to suicide plans, to suicide attempts, to completed suicide will help us help those at risk and those who are distressed but do not complete suicide,” Dr. Robert J. Ursano, lead author, told Medical Daily.

"The Army has many programs to assist, these include buddy aid and training for supervisors and encouraging soldiers to seek help," he added. "How to best help is a challenge for the Army and the nation."

Who and When

The study is a component of Army Study to Assess Risk and Resilience in Servicemembers, which seeks to identify who is at risk and when they are at risk. Ursano and his colleagues based their examination of suicide attempt risk factors on the administration records for soldiers currently deployed, previously deployed, and never deployed between 2004 and 2009. The study looked at a total of 163,178 enlisted soldiers.

Of these, 9,650 had attempted suicide: 86.3 percent were men, 68.4 percent were younger than 30, 59.8 percent were non-Hispanic white, 76.5 percent were high school educated, and 54.7 percent were currently married.

While 40.4 percent of enlisted soldiers had never been deployed, they accounted for 61.1 percent of those who attempted suicide: a total of 5,894 cases.

Overdose was the most common method of suicide attempt, yet those who attempted suicide with a firearm had most likely been currently or previously deployed.

Suicide attempts were more likely among soldiers who were women, regardless of deployment status.

“Further research is required to understand factors that may contribute to these sex differences,” concluded the researchers, who included occupational differences and the role of sexual assault or harassment in their list of possibilities.

Among soldiers with one previous deployment, odds of a suicide attempt were higher among those who screened positive for depression or posttraumatic stress disorder (PTSD) after their return and particularly at follow-up screening, about four to six months after deployment. While the link between a mental health diagnosis and suicidal behaviors is “well established,” according to Ursano and his colleagues, the magnitude of the association increased the more recent the diagnosis. Their evidence indicates three quarters of the soldiers had contact with the health care system in the month prior to a self-inflicted injury.

Noting possible limitations of the study, the researchers say their ability to establish what might have been a suicide attempt was restricted to events captured by the health care system; these events might be subject to coding errors as well as changes in policy and procedures, including the shift to electronic medical records. However, their conclusions about suicide risk are relevant to active-duty soldiers while possibly being suggestive of risks in other contexts, such as during the transition from military to civilian life.

“This is historical data — it is an Army at war,” explained Ursano. “The findings may or may not apply to an Army not at war.”

Source: Ursano RJ, Kessler RC, Stein MB, et al. Risk Factors, Methods, and Timing of Suicide Attempts Among US Army Soldiers. JAMA Psychiatry. 2016.

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