What are the timing and risk factors for suicide attempts in the army?

A new study that examined timing and risk factors for suicide attempts by U.S. Army-enlisted soldiers suggests risks were highest among those soldiers never deployed and that never-deployed soldiers were at greatest risk in the second month of service, according to an article published online by JAMA Psychiatry.

Just like suicides, suicide attempts have increased in the U.S. Army over the past decade. But suicide attempts have been studied less despite their importance as a gateway to suicide.

Robert J. Ursano, M.D., of the Uniformed Services University of the Health Sciences, Bethesda, Md., and coauthors used administrative records to examine risk factors, methods and timing of suicide attempts by soldiers currently deployed, previously deployed and never deployed from 2004 through 2009. The work is a component of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

The study included 163,178 enlisted soldiers, of whom 9,650 had attempted suicide. Of those 9,650 soldiers, 86.3 percent were men, 68.4 percent were younger than 30, 59.8 percent were non-Hispanic white, 76.5 percent were high school educated, and 54.7 percent were currently married.

The authors report that:

• The 40.4 percent of enlisted soldiers who had never been deployed accounted for 61.1 percent of the enlisted soldiers who attempted suicide (n=5,894 cases)
• Among those who had never deployed, risk of a suicide attempt was highest in the second month of service
• For soldiers on their first deployment, the risk of suicide attempt was highest in the sixth month of deployment; for previously deployed soldiers, the risk was highest five months after they returned
• Currently and previously deployed soldiers were more likely to attempt suicide with a firearm
• Across deployment status, suicide attempts were more likely among soldiers who were women, in their first two years of service, and had received a mental health diagnosis in the previous month
• Soldiers with one previous deployment had higher risk of a suicide attempt if they screened positive for depression, or posttraumatic stress disorder after they returned from deployment, especially at a follow-up screening about four to six months after deployment

There were limitations to the study, including that suicide attempts were limited to events captured by the health care system and subject to coding errors. The study also examined only a limited set of factors.

"Deployment context is important in identifying SA [suicide attempt] risk among Army-enlisted soldiers. A life/career history perspective can assist in identifying high-risk segments of a population based on factors such as timing, environmental context and individual characteristics. Our findings, while most relevant to active-duty U.S. Army soldiers, highlight considerations that may inform the study of suicide risk in other contexts such as during the transition from military to civilian life," the study concludes.