Suicide Risk in the Army (Part 2)

The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) found that much suicidal behavior (i.e. suicidal ideation, suicide plans, and histories of suicide attempts) reported by U.S. soldiers (not deployed or in basic training) began before they joined the Army. The study also found that approximately one-third of post-enlistment suicide attempts were associated with pre-enlistment mental disorders. The authors suggest that screening young people who seek to enlist in the Army for mental health disorders and identifying and treating mental health disorders among new soldiers may help reduce the Army’s suicide rate, which has increased in recent years.

The authors describe two of their findings that led to this recommendation as “striking.” These were that (1) almost half of the lifetime suicide attempts reported by soldiers occurred prior to their Army service despite the fact that a history of suicide attempts should have disqualified them from serving in the Army, and (2) more than one-third of the soldiers who first attempted suicide after they enlisted reported that they were afflicted by mental disorders before they enlisted.

The authors also report that their data analysis revealed a complex relationship among mental health disorders and suicide risk and “suggests that only a few disorders are critical predictors of suicidal behavior.” They pointed to intermittent explosive disorder (IED) as a mental health problem that “might not be foremost in the minds of clinicians as a risk factor for suicide attempts” but, in their study, was the most prevalent pre-enlistment mental health disorder identified and “was also the only pre-enlistment disorder associated with significantly elevated risk of post-enlistment first suicide attempts.” They suggest that identifying and treating IED among soldiers could be an important means of preventing suicide attempts.

Although this research determined that the suicide attempt rate among soldiers is approximately the same as in a civilian sample matched to the demographic profile of the Army sample, there is “clear evidence that the Army suicide rate…now exceeds the civilian population rate.” The authors theorized that this may reflect the fact that servicemembers use firearms to kill themselves more often than civilians do, a pattern which suggests the importance of restricting access to lethal means as a suicide prevention strategy among active duty Army servicemembers.

Being deployed at least twice was significantly associated with an increased risk of attempting suicide. The risk of attempting suicide was highest for soldiers with three or more deployments.

Other risk factors for suicidal behavior among soldiers include being a woman (women have higher rates of ideation and attempts than their male counterparts) and holding a lower rank.

Nock, M., Stein, M., Heeringa, S., Ursano, R., Colpe, L., Fullerton, C.,…Kessler, R. (2014). Prevalence and correlates of suicidal behavior among soldiers: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). JAMA Psychiatry. Advance online publication. doi: 10.1001/jamapsychiatry.2014.30

This is the second of three summaries documenting the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).