Medically Documented Suicide Ideation Among U.S. Army Soldiers

Ursano, Robert J.; Kessler, Ronald C.; Stein, Murray B.; Naifeh, James A.; Nock, Matthew K.; Aliaga, Pablo A.; Fullerton, Carol S.; Wynn, Gary H.; Ng, Tsz Hin Hinz; Dinh, Hieu M.; Sampson, Nancy A.; Kao, Tzu‐Cheg; Schoenbaum, Michael; McCarroll, James E.; Cox, Kenneth L.; Heeringa, Steven G.

doi:10.1111/sltb.12316

Cited by 16 publications

(16 citation statements)

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“…Analyses were conducted using SAS version 9.4 [23]. Enlisted soldiers and officers were examined separately owing to their different socio-demographic profiles, Army training and career experiences [24], and risk of mental health problems [25–27] and suicidal behaviors [8, 28–30]. Discrete-time person-month survival analysis with a logistic link function was used to examine multivariable associations of socio-demographic characteristics with suicide attempt.…”

Section: Methodsmentioning

confidence: 99%

Suicide attempts among activated soldiers in the U.S. Army reserve components

et al. 2019

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BackgroundAlthough the majority of active duty U.S. Army soldiers are full-time personnel in the Active Component (AC), a substantial minority of soldiers on active duty are in the Reserve Components (RCs). These “citizen-soldiers” (Army National Guard and Army Reserve) represent a force available for rapid activation in times of national need. RC soldiers experience many of the same stressors as AC soldiers as well as stressors that are unique to their intermittent service. Despite the important role of RC soldiers, the vast majority of military mental health research focuses on AC soldiers. One important goal of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is to address this gap. Here we examine predictors of suicide attempts among activated RC soldiers.MethodsThis longitudinal, retrospective cohort study used individual-level person-month records from Army and Department of Defense administrative data systems to examine socio-demographic, service-related, and mental health predictors of medically documented suicide attempts among activated RC soldiers during 2004–2009. Data from all 1103 activated RC suicide attempters and an equal-probability sample of 69,867 control person-months were analyzed using a discrete-time survival framework.ResultsEnlisted soldiers comprised 84.3% of activated RC soldiers and accounted for 95.7% of all activated RC suicide attempts (overall rate = 108/100,000 person-years, more than four times the rate among officers). Multivariable predictors of enlisted RC suicide attempts included being female, entering Army service at age ≥ 25, current age < 30, non-Hispanic white, less than high school education, currently married, having 1–2 years of service, being previously deployed (vs. currently deployed), and history of mental health diagnosis (particularly when documented in the previous month). Predictors among RC officers (overall rate = 26/100,000 person-years) included being female and receiving a mental health diagnosis in the previous month. Discrete-time hazard models showed suicide attempt risk among enlisted soldiers was inversely associated with time in service.ConclusionsRisk factors for suicide attempt in the RCs were similar to those previously observed in the AC, highlighting the importance of research and prevention focused on RC enlisted soldiers in the early phases of Army service and those with a recent mental health diagnosis.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1978-2) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Suicide attempts among activated soldiers in the U.S. Army reserve components

et al. 2019

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“…Enlisted army soldiers with medically documented SAs are more likely to be female, younger, white non‐Hispanic, and less educated than the army general population (Ursano, Kessler, Stein, et al., ). However, these same characteristics are also associated with medically documented SI (Ursano et al., ). Although a broad range of stressors is associated with lifetime SA in the general population, few predict transitions from ideation to attempt (Stein et al., ), and comparable military research is limited.…”

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confidence: 94%

Transition to suicide attempt from recent suicide ideation in U.S. Army soldiers: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

et al. 2018

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Background: Most people with suicide ideation (SI) do not attempt suicide (SA). Understanding the transition from current/recent SI to SA is important for mental health care. Our objective was to identify characteristics that differentiate SA from 30-day SI among representative U.S. Army soldiers.Methods: Using a unique case-control design, soldiers recently hospitalized for SA (n = 132) and representative soldiers from the same four communities (n = 10,193) were administered the same questionnaire. We systematically identified variables that differentiated suicide attempters from the total population, then examined whether those same variables differentiated all 30-day ideators (n = 257) from the total population and attempters from nonattempting 30-day ideators. Results: In univariable analyses, 20 of 23 predictors were associated with SA in the total population (0.05 level). The best multivariable model included eight significant predictors: interpersonal violence, relationship problems, major depressive disorder, posttraumatic stress disorder (PTSD), and substance use disorder (all having positive associations), as well as past 12-month combat trauma, intermittent explosive disorder (IED), and any college education (all having negative associations). Six of these differentiated 30-day ideators from the population. Three differentiated attempters from ideators: past 30-day PTSD (OR = 6.7 [95% CI = 1.1-39.4]), past 30-day IED (OR = 0.2 [95% CI = 0.1-0.5]), and any college education (OR = 0.1 [95% CI = 0.0-0.6]). The 5% of ideators with highest predicted risk in this final model included 20.9% of attempters, a four-fold concentration of risk. Conclusions: Prospective army research examining transition from SI to SA should consider PTSD, IED, and education. Combat exposure did not differentiate attempters from ideators. Many SA risk factors in the Army population are actually risk factors for SI.

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“…Existing research suggests that various different sociodemographic and military factors may increase the risk of suicide. For example, Ursano et al (2016) indicate that suicidal ideation in enlisted participants was more common in those who were female, younger, older at enlistment, less educated, never or previously deployed and had a recent mental health diagnosis 5. Due to the inconsistency and variations between findings shown in the literature, there is a strong suggestion for the need to study risk factors in this population.…”

Section: Introductionmentioning

confidence: 99%