Publication year
2017
Citation Title
Prior mental disorders and lifetime suicidal behaviors among US Army soldiers in the Army study to assess risk and resilience in servicemembers (Army STARRS).
Journal Name
Suicide and Life-Threatening Behavior
Page Numbers
1-20
DOI
10.1111/sltb.12394
Summary
The U.S. Army has seen an increase of suicides among Service members over recent years. The Army has addressed this increase by creating and administering a large-scale survey to assess risk and protective factors for suicidal thoughts and behaviors, titled the Army Study to Assess Risk and Resilience in Service members (Army STARRS). Data were used to analyze pre- and post-enlistment mental disorders in order to predict the time of onset for suicidal behaviors. Results highlight risk factors associated with suicide for and provide insight into the time of onset for suicidal ideation and behaviors.
Key Findings
Approximately one-half of suicidal thoughts, suicidal behaviors, and mental disorders occurred post-enlistment instead of pre-enlistment.
Certain mental disorders Service members experienced during the time of pre-enlistment (Major Depressive Disorder, Possttraumatic stress disorder, Panic Disorder, and Intermittent Explosive Disorder) were associated with suicidal attempts post-enlistment.
For men and women, Service members in the Army were at an increased risk for suicide attempts on Active Duty.
Men who had a junior enlisted rank, as opposed to being an officer, were at a greater risk for post-enlistment suicide attempts.
Implications for Program Leaders
Tailor suicide prevention efforts to Service members experiencing Major Depressive Disorder, Posttraumatic Stress Disorder, Panic Disorder, and Intermittent Explosive Disorder
Provide programs for Service members and their partners post-enlistment that focus on decreasing suicide risk
Enhance education and curriculum related to emotional regulation and suicide prevention for Service members and their families
Implications for Policy Makers
Encourage the development and continuation of programs that can promote suicide prevention for Service members, their partners, and children
Continue to support programs for Service members and their partners that address post-enlistment challenges regarding suicide, particularly for men of a junior enlisted rank
Recommend suicide prevention professional education, especially for those in contact with Active Duty Service members since they are more at risk
Methods
Data were collected from surveys administered to three groups: Active Duty Service members, Guard Soldiers, and Reservists not deployed to combat zones, Active Duty Service members deployed to combat zones in Afghanistan and Kuwait, and Service members in three Brigade Combat Teams.
Surveys included measures assessing suicidal behaviors, mental disorders, and Army career variables (e.g., rank and status and deployment history).
Researchers analyzed associations between the initial onset of suicidal behavior, mental disorders, and Army career characteristics.
Participants
Participants were Service members in the U.S. Army who completed the Consolidated All-Army Survey of the Army Study to Assess Risk and Resilience in Service members (n=29,982).
The sample included both men (n=26,927) and women (n=3,055).
The male sample was 63.4% White, 18.5% Black, 11.2% Latino, and 6.9% Multiracial. The female sample was 42% White, 34.6% Black, 13.5% Latina, and 9.9% Multiracial.
Limitations
Respondents may have under reported mental disorders or current or past suicidal thoughts and behaviors which could have increased bias in the results.
There is an increased chance that mental health data included inaccurate diagnoses or estimates since full diagnostic measures for mental disorders were not used.
Only deployed Service members were surveyed, therefore results are inconclusive for post-deployment Service members.
Avenues for Future Research
Include more women in future samples to more accurately compare results across gender
Survey Veterans and Reservists in future studies in order to determine if results subsist post-deployment
Use full diagnostic measures for mental disorders in order to improve accuracy
Focus
Army
Target Population
Population Focus
Military Branch
Military Component
Abstract
We report on associations of retrospectively reported temporally prior mental disorders and Army career characteristics with subsequent first onset of suicidal behaviors in a large, representative sample of US Army soldiers who participated in the Consolidated All-Army Survey of the Army Study to Assess Risk and Resilience in Servicemembers (N = 29,982). Results reveal that among men and women, all self-reported lifetime disorders measured (some assessed with screening scales) are associated with subsequent onset of suicide ideation. Among men, three disorders characterized by agitation and impulsiveness (intermittent explosive disorder, panic disorder, and substance disorders) predict the transition from suicide ideation to attempt. For both men and women, being in the Regular Army (vs. National Guard or Army Reserve) predicts suicide attempts in the total sample. For men, a history of deployment and junior rank are predictors of suicide attempts after adjusting for preenlistment disorders but not accounting for pre- and postenlistment disorders, suggesting that postenlistment disorders account for some of the increased suicide risk among these career characteristics. Overall, these results highlight associations between mental disorders and suicidal behaviors, but underscore limitations predicting which people with ideation attempt suicide.
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