SOURCES: Robert J. Ursano, M.D., professor and chair, department of psychiatry, and director, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Md.; Mark Kaplan, Dr.P.H., professor of social welfare, Luskin School of Public Affairs, University of California, Los Angeles; July 8, 2015, JAMA Psychiatry, online
THURSDAY, July 9, 2015 (HealthDay News) -- Among U.S. Army personnel, enlisted soldiers on their first tour of duty appear to be most at risk for attempted suicide, a new study finds.
Concerned by a spike in suicides and suicide attempts in the Army during the Iraq and Afghanistan wars, researchers set out to identify key risks for suicide attempts between 2004 and 2009.
"Those who were female, younger, early in their career, with a recent mental health problem, and never or previously deployed were at greatest risk," said study lead author Dr. Robert Ursano, chair of psychiatry at the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences in Bethesda, Md.
"By understanding who is at risk and when they are at risk, we can much better target treatments," Ursano said.
The findings were published in the July 8 online issue of JAMA Psychiatry.
In 2014, as part of the Army's Study to Assess Risk and Resilience in Servicemembers, investigators analyzed monthly records of suicide attempts collected by the Army and the U.S. Department of Defense.
The study team focused on records that registered suicide attempts, as opposed to completed suicides, among active-duty regular Army soldiers from 2004 through 2009. Neither former Army personnel nor those treated outside the Army's health-care system were included in the tally.
During that time, nearly 9,800 Army personnel attempted suicide, according to the report.
Although enlisted soldiers make up roughly 84 percent of the active-duty Army pool, they made up nearly 99 percent of the attempts, the researchers found. By contrast, commissioned and warrant officers made up just 1.4 percent of the attempts.
Women, whether officers or enlisted, were more than twice as likely as men to attempt suicide, the study found.
Also, the risk for attempted suicide was 13 times higher among female enlisted soldiers than female officers. It was 16 times higher among enlisted soldiers entering the Army at age 25 and older compared to officers entering the Army at a similar age. Risk was also higher for whites; those with less than a high school education; those in the first four years of service; those who had never been deployed; and those diagnosed with a mental health condition in the prior month.
The risk for a suicide attempt among enlisted soldiers was highest in the second month of service, though risk dropped significantly the longer a soldier served, the investigators found.
Among officers, the risk for a suicide attempt remained steady over time, and was associated with being a woman, being 40 and up, entering the Army at 25 or older, and having a mental health diagnosis in the prior month.
Ursano suggested that the current effort offers an "unprecedented opportunity for understanding suicide as a disorder."
He also said that the findings offer "great promise for dramatically changing our understanding and opportunities for intervention for suicide and mental health problems in (both the) Army and the nation."
Mark Kaplan, a professor of social welfare with the Luskin School of Public Affairs at the University of California, Los Angeles, said the investigation addresses an important problem.
"But in addition to the pieces of the risk puzzle presented here, which focus mostly on personal psychology, it is also important to understand how the social organizational context of the Army affects these individual vulnerabilities," Kaplan added. "We really don't yet fully understand the connection between the two."
He said those specific tipping factors can include job strain; the role of leadership; financial stress; the impact of multiple deployments; and the need to readjust back to family life and the role of firearms. The psychological demands and limited decision-making that characterize day-to-day life among people at the bottom of the Army ladder are also a consideration, he added.
"Going forward, it'll be important to appreciate the complexity of the suicide," he said, "to view it both as a personal as well as a social phenomenon."
The American Association of Suicidology talks about depression and suicide.