Suicide Risk in the Army. Part 1.

The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) found that from 2004 to 2009, the suicide rate among soldiers deployed in support of the conflicts in Afghanistan and Iraq was higher than the rate among soldiers who served during the same period but had never been deployed. This increased risk was found among soldiers who were currently deployed as well as those who had been deployed in the past but were not currently deployed. The suicide rate increased among servicemembers during the study period, including for those who were not and had never been deployed. The authors suggest that this finding “argues indirectly against the view that exposure to combat-related trauma is the exclusive cause of the increase.”

The data analysis identified several additional risk factors associated with suicide among Army servicemembers including being a man, being white, holding a junior enlisted rank, having being demoted in the past two years, and not having a high school or equivalency diploma. Younger soldiers (17–20 years of age) were at “markedly” increased suicide risk during and after deployment. The data analysis also revealed that “suicide risk is generally inversely related to length of Army service, with particularly high risk among currently and previously deployed soldiers in their first two years of service.”

Soldiers who are married or have dependents have significantly lower suicide risk than other soldiers during deployment although being married or having dependents does not appear to lower the suicide risk for soldiers who have never been deployed or who have returned from deployment.

The data analysis did not find an association between suicide risk and stop loss orders (when the Army requires a soldier to remain in the service past his or her original enlistment period) or accession waivers (which allow people to enlist in the Army who do not meet the regular enlistment standards because of a medical condition, lack of educational achievement, criminal history, etc.). The authors report that the lack of an association between suicide risk and accession waivers was unexpected given that other research has shown that these waivers are associated with risk factors including alcohol and drug use and conduct problems.

The authors also point out that their finding that elevated suicide risk is associated with current and previous deployment is in direct contradiction to the results reported by the Millennium Cohort Study (MCS), which showed no association between deployment history and suicide. They attribute this difference in results to two methodological differences: first, that the  MCS studied all branches of the services and aggregated the data, whereas STARRS studied only the Army; and second, that STARRS drew on population data from military records, while MCS was based on a survey sample with a low response rate. MCS relied on survey data, and people with emotional problems can be reluctant to participate in such surveys.

Schoenbaum, M., Kessler, R., Gilman, S., Colpe, L., Heeringa, S., Stein, M., Ursano, R., & Cox, K. (2014). Predictors of suicide and accident death in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). JAMA Psychiatry. Published online March 3, 2014.

This is the first of three summaries documenting the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). A summary of the MCS data described in the last paragraph of this Research Summary can be found in the November 1, 2013 Weekly Spark.