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Risk Factors for Army Suicide Attempts in Iraq, Afghanistan Identified

Risk factors for regular Army suicide attempts by enlisted soldiers and officers in Iraq and Afghanistan have been identified, and socio-demographic factors, length of service, deployment history, and the presence and recency of a mental health diagnosis are among the primary predictors, according to a study published July 8 in JAMA Psychiatry. Enlisted Army service members in their second month of service were at greatest risk for attempting suicide.

The study, "Suicide Attempts in the U.S. Army during the wars in Afghanistan and Iraq, 2004-2009," used data from the Army Study to Assess Risk and Resilience in Service members (Army STARRS), the largest study of mental health risk and resilience ever conducted among U.S. Army personnel. From 2004 through 2009, the Army experienced the longest sustained increase in suicide rates relative to the other U.S. military branches. Rates of non-fatal suicide attempts among soldiers rose sharply during this time in parallel with the trend in suicide deaths, yet researchers' understanding of Army suicide attempts remains limited.

Robert J. Ursano, MD, chair of the department of psychiatry and director of the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences, Murray B. Stein, MD, MPH, professor of Psychiatry and Family and Preventive Medicine at the University of California, San Diego, both 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, which included 975,057 Regular Army soldiers (i.e., excluding those in the U.S. Army National Guard and Army Reserve).

The study found that enlisted soldiers accounted for 98.6% of all suicide attempts (377 per 100,000 person-years) versus 1.4% (27.9 per 100,000 person-years) for officers.

Enlisted soldiers had higher odds for a suicide attempt if they were female, had entered the Army at 25 or older, were currently 29 or younger, didn't complete high school, were in their first four years of service, and had a mental health diagnosis during the previous month. The risk was highest in the second month of service and declined as the length of service increased. Black, Hispanic, and Asian service members had a lower risk for suicide attempts. Enlisted soldiers who were never deployed or who had previously deployed were at greater risk for attempting suicide than those who were currently deployed.

Among officers (both commissioned and warrant), who accounted for 141 cases, only socio-demographic characteristics (female, older age at Army entry, younger current age, and low education) and the presence and recency of mental health diagnoses were significant. Female officers who entered the Army at age 25 or older and had a mental health diagnosis in the previous month constituted the greatest risk for suicide attempt. Length of service and deployment status was not associated with suicide attempt among officers.

Researchers also estimate that enlisted women had nearly 13 times the risk of female officers for a suicide attempt, and enlisted soldiers who entered the Army at 25 years or older had more than 16 times the risk of officers in the same group for a suicide attempt.

"Suicide attempts have different predictors than suicide," says Ursano. "They identify a group for intervention and preventive care. [Identifying] who is at risk and when they are at greatest risk can aid the development of targeted interventions."

The results represent the most comprehensive accounting of U.S. Army suicide attempts to date and reveal unique risk profiles for enlisted soldiers and officers, and highlights the importance of focusing research and prevention efforts on enlisted soldiers in their first tour of duty.

--Source: Uniformed Services University of the Health Sciences