Suicide attempts in U.S. Army combat arms, special forces and combat medics

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

doi:10.1186/s12888-017-1350-y

Cited by 22 publications

(25 citation statements)

References 51 publications

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“…The reason for this discrepancy between RC and AC soldiers is not yet known but may be attributable to differences in socio-demographic and occupational composition (e.g., the U.S. Army Reserve does not have combat units). A more detailed analysis of risk by deployment status [7] and military occupation [37] may improve understanding of how the association of deployment status with suicide attempts may differ between the RCs and AC.…”

Section: Discussionmentioning

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: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…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.…”

Section: Discussionmentioning

confidence: 96%

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

Naifeh

Ursano

Kessler

et al. 2019

Suicide & Life Threat Behav

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Objective We examined early first deployment and subsequent suicide attempt among U.S. Army soldiers. Method Using 2004–2009 administrative data and person‐month records of first‐term, Regular Army, enlisted soldiers with one deployment (89.2% male), we identified 1,704 soldiers with a documented suicide attempt during or after first deployment and an equal‐probability control sample (n = 25,861 person‐months). Results Logistic regression analyses indicated soldiers deployed within the first 12 months of service were more likely than later deployers to attempt suicide (OR = 1.7 [95% CI = 1.5–1.8]). Adjusting for sociodemographic characteristics, service‐related characteristics, and previous mental health diagnosis slightly attenuated this association (OR = 1.6 [95% CI = 1.5–1.8]). Results were not modified by gender, deployment status, military occupation, or mental health diagnosis. The population‐attributable risk proportion for deploying within the first 12 months of service was 17.8%. Linear spline models indicated similar risk patterns over time for early and later deployers, peaking at month 9 during deployment and month 5 postdeployment; however, monthly suicide attempt rates were consistently higher for early deployers. Conclusions Enlisted soldiers deployed within the first 12 months of service have elevated risk of suicide attempt during and after first deployment. Improved understanding of why early deployment increases risk can inform the development of policies and intervention programs.

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“…This includes some, but not all, of the occupations traditionally classified as combat arms (eTable 2). Previous research indicates that these combat arms soldiers are at elevated risk of suicide attempt compared to other occupations (Ursano et al, 2017). We also created an indicator variable for any prior mental health diagnosis during Army service by combining categories derived from administrative medical record ICD-9-CM codes (e.g., major depression, bipolar disorder, posttraumatic stress disorder, personality disorders), excluding postconcussion syndrome, tobacco use disorder, and supplemental V-codes that are not disorders (e.g., stressors/adversities, marital problems) (eTable 3).…”

Section: Methodsmentioning

confidence: 99%

“…Understanding factors that predict suicide attempts is important for risk detection and prevention. Previous research has examined risk as a function of socio-demographics and service-related characteristics, such as deployment history (Ursano et al, 2015a; Ursano et al, 2015b; Ursano et al, 2017). Little attention has been focused on the association of family violence with suicide attempts.…”

Section: Introductionmentioning

confidence: 99%

“…Adjusting for basic socio-demographic and service-related variables, we examined the overall association of family violence with suicide attempt, as well as factors that have received little attention in previous studies, such as the number and recency of family violence events, and a soldier’s role as perpetrator or victim. We also examined whether the association of family violence with suicide attempt varied by gender, deployment status (never deployed, currently deployed, previously deployed), and time in service, which are associated with suicide attempts among soldiers (Ursano et al, 2015a; Ursano et al, 2015b; Ursano et al, 2017) and may play unique roles in modifying the effects of family violence. History of family violence may carry different risks based on phases of deployment, which may be particularly salient for those who have been exposed to combat, and may be influenced by family stressors upon return home.…”

Section: Introductionmentioning

confidence: 99%

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Documented family violence and risk of suicide attempt among U.S. Army soldiers

Ursano

Stein

Mash

et al. 2018

Psychiatry Research

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Suicide attempt (SA) rates in the U.S. Army increased substantially during the wars in Afghanistan and Iraq. This study examined associations of family violence (FV) history with SA risk among soldiers. Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), we identified person-month records of active duty, Regular Army, enlisted soldiers with medically documented SAs from 2004 to 2009 (n = 9650) and a sample of control person-months (n = 153,528). Logistic regression analyses examined associations of FV with SA, adjusting for socio-demographics, service-related characteristics, and prior mental health diagnosis. Odds of SA were higher in soldiers with a FV history and increased as the number of FV events increased. Soldiers experiencing past-month FV were almost five times as likely to attempt suicide as those with no FV history. Odds of SA were elevated for both perpetrators and those who were exclusively victims. Male perpetrators had higher odds of SA than male victims, whereas female perpetrators and female victims did not differ in SA risk. A discrete-time hazard function indicated that SA risk was highest in the initial months following the first FV event. FV is an important consideration in understanding risk of SA among soldiers.

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Suicide attempts in U.S. Army combat arms, special forces and combat medics

Cited by 22 publications

References 51 publications

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

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

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

Documented family violence and risk of suicide attempt among U.S. Army soldiers

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