Suicide Risk in the Army (Part 3)

The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) found DSM-IV disorders [i.e. mental disorders] to be more prevalent among soldiers than among a sociodemographically matched group of civilians. Over a 30-day period, 25 percent of the sample met the criteria for at least one DSM-IV disorder and 11 percent met the criteria for more than one disorder.  Seventy-seven percent of the soldiers with a disorder or disorders reported that at least one of their disorders began prior to joining the Army.

The DSM-IV disorders used in the analysis included both externalizing disorders (i.e. attention-deficit/hyperactivity disorder, intermittent explosive disorder, alcohol/drug disorder) and internalizing disorders (i.e. major depressive disorder, bipolar disorder, generalized anxiety disorder, panic disorder, and posttraumatic stress disorder). The most prevalent disorders in the sample (which excluded soldiers currently in basic training or deployed) were intermittent explosive disorder (11.2 percent), posttraumatic stress disorder (8.6 percent), and attention deficit/hyperactivity disorder (7 percent).  

Almost all the disorders were positively associated with the number of times a soldier had been deployed (that is, the greater the number of deployments, the greater the risk of having a disorder). This association was statistically significant for major depressive disorder, bipolar disorder, generalized anxiety disorder, and intermittent explosive disorder.

The lower the rank of the soldier, the more likely they were to have at least one disorder. Female soldiers were more at risk for disorders than their male peers.

Almost 13 percent of those with disorders reported severe role impairment – that is, the disorder interfered with their ability to do their job. The authors report that “severe role impairment was substantially more common among soldiers with than without DSM-IV mental disorders.”  Of soldiers reporting severe role impairment, 61.5 percent had at least one DSM-VI disorder.

The authors presume that the higher rate of soldiers with pre-enlistment externalizing disorders (compared to a matched civilian sample) “reflected selection processes in the current all-volunteer Army” while the higher rate of internalizing disorders in the Army sample seemed be a result of the percentage of these disorders that began after enlistment.

The authors recognize the difficulty of screening potential recruits for disorders prior to enlistment given the reluctance of many recruits to admit any mental health issues. The authors suggest that the Army develop “targeted outreach-intervention programs for new soldiers.”

Kessler, R.C., Heeringa, S.G., Stein, M.B., Colpe, L.J., Fullerton, C.S., Hwang, I., Naifeh, J.A., …Ursano, R.J. (2014). Thirty-day prevalence of DSM-IV Mental disorders among nondeployed soldiers in the US Army. JAMA Psychiatry. Advance online publication. doi: 10.1001/jamapsychiatry.2014.30.

This is the third of three summaries documenting the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Although this article does not report on suicidal behavior per se, most of the DSM-IVmental disorders included in the analysis are risk factors for suicide.