Occupational differences in US Army suicide rates

Abstract

Background Civilian suicide rates vary by occupation in ways related to occupational stress exposure. Comparable military research finds suicide rates elevated in combat arms occupations. However, no research has evaluated variation in this pattern by deployment history, the indicator of occupation stress widely considered responsible for the recent rise in the military suicide rate. Method The joint associations of Army occupation and deployment history in predicting suicides were analysed in an administrative dataset for the 729 337 male enlisted Regular Army soldiers in the US Army between 2004 and 2009. Results There were 496 suicides over the study period (22.4/100 000 person-years). Only two occupational categories, both in combat arms, had significantly elevated suicide rates: infantrymen (37.2/100 000 person-years) and combat engineers (38.2/100 000 person-years). However, the suicide rates in these two categories were significantly lower when currently deployed (30.6/100 000 person-years) than never deployed or previously deployed (41.2–39.1/100 000 person-years), whereas the suicide rate of other soldiers was significantly higher when currently deployed and previously deployed (20.2–22.4/100 000 person-years) than never deployed (14.5/100 000 person-years), resulting in the adjusted suicide rate of infantrymen and combat engineers being most elevated when never deployed [odds ratio (OR) 2.9, 95% confidence interval (CI) 2.1–4.1], less so when previously deployed (OR 1.6, 95% CI 1.1–2.1), and not at all when currently deployed (OR 1.2, 95% CI 0.8–1.8). Adjustment for a differential ‘healthy warrior effect’ cannot explain this variation in the relative suicide rates of never-deployed infantrymen and combat engineers by deployment status. Conclusions Efforts are needed to elucidate the causal mechanisms underlying this interaction to guide preventive interventions for soldiers at high suicide risk.

Lifetime Suicidal Behaviors and Career Characteristics Among U.S. Army Soldiers: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

“…This is inconsistent with prior studies reporting increased suicide death among combat arms occupations (Helmkamp, 1996; Kessler et al, 2015; LeardMann, Powell, Smith, & et al, 2013; Trofimovich et al, 2013), but consistent with a recent case-control study that found that, compared with troops in other occupations, those in combat-related occupations had a lower prevalence of suicide attempts and no greater risk of suicide death (Skopp et al, 2016). There are at least two explanations why these occupations would be associated with suicide death but not non-lethal suicidal behaviors.…”

“…combat arms; (Gadermann et al, 2014) have higher rates of suicide death than those in other occupations (Helmkamp, 1996; Kessler et al, 2015; Trofimovich, Reger, Luxton, & Oetjen-Gerdes, 2013), but it is not known whether these associations apply as well to the range of suicidal behaviors considered in this report. In addition to rank and occupation, differences in suicidal behavior may vary among Regular Army and G/R components.…”

“…Consistent with previous work on occupational differences in soldier health (Gubata, Piccirillo, Packnett, & Cowan, 2013; Lindstrom et al, 2006; Niebuhr et al, 2011), we distinguished three broad classes of occupations: combat arms occupations, which are involved directly in ground combat; combat support occupations, which provide operational assistance to combat arms; and all other occupations, which are referred to collectively as combat service support occupations (Kirin & Winkler, 1992; Layne, Naftel, Thie, & Kawata, 2001). A more detailed discussion of MOS coding in STARRS is presented elsewhere (Kessler et al, 2015). …”

“…The second aim is to expand the Nock et al (2014) analysis to examine associations of three critical Army career characteristics – rank, occupation, and component (i.e., Regular Army versus Army National Guard/Army Reserve) -- with self-reported suicidal behaviors separately for the subset of these behaviors that began prior to enlistment and those that began only after enlistment. This specification goes beyond previous studies, a number of which have documented associations of these career characteristics with suicidality (Kessler et al, 2015; Nock et al, 2014; Ursano, Heeringa, et al, 2015; Ursano, Kessler, Stein, et al, 2015), by investigating the possibility that these associations are due to selection processes rather than to experiences associated with the career characteristics (e.g., higher exposure to traumatic experiences by soldiers in combat arms occupations than other occupations) (Nock et al, 2014). We did this by treating these career characteristics as predictors of first onset of the outcomes both before and after age-at-enlistment.…”

Risk of Suicide Attempt Among Soldiers in Army Units With a History of Suicide Attempts

“…Military occupation has been shown to influence suicide risk, with combat soldiers having significantly elevated rates of suicide death compared to other soldiers. 19 It is not known if this increased risk is associated with the number of previous unit suicides or SAs. Unit size is another potentially relevant characteristic.…”