Medically Documented Suicide Ideation Among U.S. Army Soldiers

Authors

Robert J. Ursano, Uniformed Services University of the Health SciencesFollow
Ronald C. Kessler, Harvard Medical SchoolFollow
Murray B. Stein, University of California - San DiegoFollow
James A. Naifeh, Uniformed Services University of the Health Sciences
Matthew K. Nock, Harvard UniversityFollow
Pablo A. Aliaga, Uniformed Services University of the Health Sciences
Carol S. Fullerton, Uniformed Services University of the Health Sciences
Gary H. Wynn, Uniformed Services University of the Health Sciences
Tsz Hin Hinz Ng, Uniformed Services University of the Health Sciences
Hieu M. Dinh, Uniformed Services University of the Health Sciences
Nancy A. Sampson, Harvard Medical School
Tzu-Cheng Kao, Uniformed Services University of the Health Sciences
Michael Schoenbaum, National Institute of Mental Health
James E. McCarroll, Uniformed Services University of the Health Sciences
Kenneth L. Cox, U.S. Army Public Health Center
Steven G. Heeringa, University of Michigan - Ann Arbor
Army STARRS Team

Date of this Version

2016

Citation

Suicide and Life-Threatening Behavior, pp. 1-17, DOI: 10.1111/sltb.12316.

Comments

U.S. government work.

Abstract

We used administrative data to examine predictors of medically documented suicide ideation (SI) among Regular Army soldiers from 2006 through 2009 (N = 10,466 ideators, 124,959 control person-months). Enlisted ideators (97.8% of all cases) were more likely than controls to be female, younger, older when entering service, less educated, never or previously deployed, and have a recent mental health diagnosis. Officer ideators were more likely than controls to be female, younger, younger when entering service, never married, and have a recent mental health diagnosis. Risk among enlisted soldiers peaked in the second month of service and declined steadily, whereas risk among officers remained relatively stable over time. Risk of SI is highest among enlisted soldiers early in Army service, females, and those with a recent mental health diagnosis.

In recent years, there have been several large-scale efforts to understand the sharp increase in fatal (LeardMann et al., 2013; Reger et al., 2015; Schoenbaum et al., 2014) and nonfatal (Nock et al., 2014; Ursano, Kessler, Heeringa, et al., 2015; Ursano, Kessler, Stein, et al., 2015) suicidal behaviors among U.S. military personnel that occurred during the wars in Iraq and Afghanistan. Suicide ideation (SI) is an important outcome both as an indicator of distress and as a predictor of more serious suicidal behavior (Kessler, Borges, & Walters, 1999; Nock et al., 2014; Ursano, Heeringa, et al., 2015). The lifetime prevalence of SI is approximately 14% among active duty Regular Army soldiers (Nock et al., 2014). The sociodemographic correlates of ideation in service members, including female gender, younger age, and non-Hispanic White race and ethnicity (Nock et al., 2014; Ursano, Kessler, Heeringa, et al., 2015) are consistent with those of the U.S. general population (Borges, Angst, Nock, Ruscio, & Kessler, 2008; Kessler, Berglund, Borges, Nock, & Wang, 2005). Risk of attempting or dying by suicide is higher among enlisted soldiers in their first tour of duty (Gilman et al., 2014; Ursano, Kessler, Stein, et al., 2015), but the relationship of time in service with SI is not yet known. Although the influence of deployment on adverse mental health outcomes is well supported (Bray et al., 2010; Gadermann et al., 2012; Jacobson et al., 2008; Shen, Arkes, & Williams, 2012; Wells et al., 2010), the association of deployment with suicidal thoughts and behaviors has generated inconsistent results (Bryan et al., 2015). Prior mental disorders are a robust predictor of both fatal (Black, Gallaway, Bell, & Ritchie, 2011) and nonfatal (Ursano, Kessler, Stein, et al., 2015) suicidal behaviors in service members, findings in line with a large body of civilian research (Harris & Barraclough, 1997; Nock, Hwang, Sampson, & Kessler, 2010).