Researchers assess non-fatal suicidal behaviors in US Army administrative records

Although the U.S. Army suicide rate is known to have risen sharply over the past decade, information about medically documented, non-fatal suicidal behaviors is far more limited. According to findings published in Psychiatry: Interpersonal & Biological Processes incidence rates of suicide ideation and suicide attempts increased annually among Soldiers during the years 2004-2009. This study provides the most comprehensive picture to date of non-fatal suicidal events in the U.S. Army.

The study used data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), the largest study of mental health risk and resilience ever conducted among U.S. Army personnel. Robert J. Ursano, MD, chair of the Department of Psychiatry at the Uniformed Services University and Murray B. Stein, MD, MPH, Professor of Psychiatry and Family and Preventive Medicine at the University of California, San Diego, co-principal investigators for Army STARRS, and a team of Army STARRS researchers looked at data for more than 1.66 million Soldiers who served on active duty from January 1, 2004 to December 31, 2009. This includes 975,057 Regular Army Soldiers (i.e., excluding those in the U.S. Army National Guard and Army Reserve) comprising 37 million person-months of service.

Professor Sir Simon Wessely, MD, Chair of Psychological Medicine and Vice Dean for Academic Psychiatry, King's College, London and President of the Royal College of Psychiatrists is a commentator on the paper. Dr. Simon stated, "Big health data" such as in this study, can revolutionize the future of epidemiological research" and can advance suicide research. Dr. Robert Bossarte, Director, Epidemiology Program, Office of Public Health, Department of Veterans Affairs stated in his commentary, "By developing a framework for categorizing suicide ideation and attempt in groups including both definite or probable events, depending on data source and reporting requirements, Dr. Ursano and colleagues have provided a crucial template for reliably integrating data on non-fatal suicide behaviors into studies of self-harm and evaluation of suicide prevention programs."

In this study, from 2004-2009, the investigators report on 21,740 unique Soldiers who had a suicide attempt, suspicious injury, or suicide ideation. This includes 9,791 suicide attempts. The rate of definite and probable suicide attempt was 319 per 100,000 person years. The annual rates of definite suicide attempts were approximately three to eight times higher than those of suicide deaths. When probable suicide attempts are included, the attempt-to-death ratio was in the range 13-22. Unlike suicide attempts and suicide ideation, the Army's annual incidence rate of suspicious injuries remained stable and was not correlated with any other outcomes. Future examination of suspicious injuries in combination with mental health records may reveal whether these events are relevant to the study of non-fatal suicidal events in the Army or are truly distinct.

For each non-fatal event category (suicide attempts, suicide ideation and suspicious injury), the study found higher odds among those who are female, Non-Hispanic White, never married, lower ranking enlisted, have less than a high school education, and entered Army service prior to age 21. Findings suggest that gender has the largest discrepancy, with females 2.0-2.3 times more likely than males to make a suicide attempt but only 1.4-1.5 times more likely to have suicide ideation. Better awareness of, and increased attention to, non-fatal suicidal events may provide an opportunity for prevention of suicide deaths.