Risk Factors, Methods, and Timing of Suicide Attempts Among US Army Soldiers

Abstract

IMPORTANCE Suicide attempts in the US Army have risen in the past decade. Understanding the association between suicide attempts and deployment, as well as method and timing of suicide attempts, can assist in developing interventions. OBJECTIVE To examine suicide attempt risk factors, methods, and timing among soldiers currently deployed, previously deployed, and never deployed at the time this study was conducted. DESIGN, SETTING, AND PARTICIPANTS This longitudinal, retrospective cohort study of Regular Army–enlisted soldiers on active duty from 2004 through 2009 used individual-level person-month records to examine risk factors (sociodemographic, service related, and mental health), method, and time of suicide attempt by deployment status (never, currently, and previously deployed). Administrative data for the month before each of 9650 incident suicide attempts and an equal-probability sample of 153 528 control person-months for other soldiers were analyzed using a discrete-time survival framework. MAIN OUTCOMES AND MEASURES Suicide attempts and career, mental health, and demographic predictors were obtained from administrative and medical records. RESULTS Of the 9650 enlisted soldiers who attempted suicide, 86.3% were male, 68.4% were younger than 30 years, 59.8% were non-Hispanic white, 76.5%were high school educated, and 54.7% were currently married. The 40.4% of enlisted soldiers who had never been deployed (n = 12 421 294 person-months) accounted for 61.1% of enlisted soldiers who attempted suicide (n = 5894 cases). Risk among those never deployed was highest in the second month of service (103 per 100 000 person-months). Risk among soldiers on their first deployment was highest in the sixth month of deployment (25 per 100 000 person-months). For those previously deployed, risk was highest at 5 months after return (40 per 100 000 person-months). Currently and previously deployed soldiers were more likely to attempt suicide with a firearm than those never deployed (currently deployed: OR, 4.0; 95% CI, 2.9–5.6; previously deployed: OR, 2.7; 95% CI, 1.8–3.9). Across deployment status, suicide attempts were more likely among soldiers who were women (currently deployed: OR, 3.4; 95% CI, 3.0–4.0; previously deployed: OR, 1.5; 95% CI, 1.4–1.7; and never deployed: OR, 2.4; 95% CI, 2.3–2.6), in their first 2 years of service (currently deployed: OR, 1.9; 95% CI, 1.5–2.3; previously deployed: OR, 2.2; 95% CI, 1.9–2.7; and never deployed: OR, 3.1; 95% CI, 2.7–3.6), and had a recently received a mental health diagnosis in the previous month (currently deployed: OR, 29.8; 95% CI, 25.0–35.5; previously deployed: OR, 22.2; 95% CI, 20.1–24.4; and never deployed: OR, 15.0; 95% CI, 14.2–16.0). Among soldiers with 1 previous deployment, odds of a suicide attempt were higher for those who screened positive for depression or posttraumatic stress disorder after return from deployment and particularly at follow-up screening, about 4 to 6 months after deployment (depression: OR, 1.4; 95% CI, 1.1–1.9; posttraumatic stres...

Early First Deployment and Risk of Suicide Attempt Among First‐term Enlisted Soldiers in the U.S. Army

“…These findings suggest that although earlier deployment carries increased risk during and after deployment, the timing of the risk—which is similar for both early and later deployers—may be more related to the cycles of stressors that soldiers experience in‐theater and after returning home. These patterns of suicide attempt risk during and after first deployment are generally similar to previous findings based on the full population of enlisted soldiers (Ursano et al, ). They are also consistent with patterns of self‐reported mental health outcomes, such as depression (Mental Health Advisory Team (MHAT‐V), ; Milliken, Auchterlonie, & Hoge, ).…”

“…Among first‐term enlisted soldiers, odds of suicide attempt during and after first deployment were approximately 70% higher for those who deployed within the first 12 months of service. This association persisted after adjusting for sociodemographic and service‐related characteristics known to be associated with suicide attempts, including combat arms occupation (Ursano, Kessler, Naifeh, et al, ; Ursano, Kessler, Stein, et al, ; Ursano et al, ). Importantly, this association remained, only slightly attenuated, after adjusting for previous mental health diagnosis, indicating that this risk was not explained by mental health problems identified prior to deployment.…”

“…The mechanisms through which early first deployment increases risk of suicide attempt are not yet known. Studies indicate that rates of documented suicide ideation and attempts are highest during the first year of service (Ursano, Kessler, Stein, et al, ; Ursano et al, ; Ursano, Kessler, Stein, et al, ), suggesting that this initial period of intensive training and Army acculturation is particularly challenging for some soldiers (Klein, Hawes‐Dawson, & Martin, ). For those who deploy during this early career phase, the stress associated with adapting to the Army may be compounded by numerous predeployment and peri‐deployment individual and familial stressors (La Bash, Vogt, King, & King, ; Maguen et al, ; Troxel, Trail, Jaycox, & Chandra, ; Watkins, ).…”

“…Soldiers in their first term of enlistment are at substantially increased risk of attempting suicide compared to those who have served longer (Ursano, Kessler, Stein, et al, ; Ursano et al, ). Importantly, more than half of soldiers deployed in support of the wars in Iraq and Afghanistan had only one deployment (Institute of Medicine, ).…”

Sex Differences in Suicide-Related Symptoms in a Large Military Sample

“…Previous research has found that male active duty servicemembers are more likely to die by suicide than female active duty servicemembers (Black, Shayne, Bell, & Ritchie, 2011; Ramchand et al, 2011). However, other findings indicate that the suicide rate, proportional to gender distributions in the military among those who are deployed, is more pronounced among female servicemembers (Street et al, 2015; Ursano et al, 2016). A recent study by Nock and colleagues (2014) also found that female Army servicemembers had significantly higher rates of suicidal ideation and suicide attempts than their male counterparts.…”