Enlisted soldiers in their first tour of duty are the most likely to attempt suicide, says an analysis of US Army data published in JAMA Psychiatry (Ursano et al., 2015). The risk was particularly high among soldiers with a recent mental health diagnosis, the longitudinal retrospective cohort study found.

In recent years the rate of suicide attempts in the US Army has increased sharply during the wars in Afghanistan and Iraq. The researchers looked at the records of 975,057 regular army soldiers on active duty from January 2004 to December 2009. Some 9,791 suicide attempts were documented during that period, but deaths from suicide were not included. The researchers used data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), which is sponsored by the US Army and funded by the National Institutes of Health.

Enlisted soldiers constituted about 84% of the army and nearly 99% of suicide attempts recorded in the study. Officers, both commissioned and warrant, constituted 16.5% of the regular army and accounted for 1.4% of cases. Female enlisted soldiers were more than twice as likely as male enlisted soldiers to attempt suicide (odds ratio 2.4 (95% confidence interval 2.2 to 2.6)), but they constituted only 13.7% of the active duty regular army.

The risk of attempted suicide among enlisted soldiers was highest in the second month of service and declined as the length of service increased. Other risk factors included entering the army at age 25 or older, not completing high school, and being in the first four years of service. Non-Hispanic white soldiers were at greater risk of attempting suicide than black, Hispanic, or Asian soldiers, the study found.

Suicide attempts were associated with mental health diagnoses, particularly within the previous month (odds ratio 18.2 (17.4 to 19.1)). Almost 60% of enlisted soldiers and 70% of officers received such a diagnosis before their suicide attempt, suggesting that many soldiers at risk have already been identified by the army’s healthcare system as needing mental health services.

A limitation of the study is that it focused only on suicide attempts documented by the army healthcare system. The authors noted that undocumented suicide attempts, including self pay treatment at civilian healthcare facilities, might have different risk factors. They were also unable to examine suicide attempts among people who had recently left the army.

Reference (Whole Article)

BMJ 2015;351:h3702

Reference (In Article)

Ursano, R., Kessler, R., Stein, M., et al. (2015) Suicide Attempts in the US Army during the Wars in Afghanistan and Iraq, 2004 to 2009. JAMA Psychiatry. July 2015. doi:10.1001/jamapsychiatry.2015.0987.