Publication year
2015
Citation Title
Mental disorder, comorbidity, and pre-enlistment suicidal behavior among new soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Service members (Army STARRS).
Journal Name
Suicide and Life Threatening Behavior
Journal Volume
45
Issue Number
5
Page Numbers
588-599
DOI
10.1111/sltb.12153
Summary
Newly recruited Soldiers participated in a study examining the associations between mental disorders and suicidal behavior (ideation, plans, and attempts). Having a mental disorder was associated with increased odds of suicidal behavior. Only posttraumatic stress disorder (PTSD) and other mental health disorders (those characterized by irritability and impulsive and aggressive behavior) predicted unplanned suicide attempts among those who thought about suicide.
Key Findings
Most new Soldiers who had attempted suicide prior to enlistment had a mental disorder, commonly including intermittent explosive disorder and chemical dependency.
Each mental health disorder examined was significantly associated with increased odds of suicidal ideation and attempts.
No single disorder assessed in this study predicted which Soldiers with a suicidal plan would go on to make a suicide attempt.
Only PTSD, bipolar disorder, chemical dependency, and oppositional defiant disorder predicted which Soldiers would move beyond suicidal ideation to unplanned attempts.
Implications for Program Leaders
Disseminate information about suicide hotline and intervention resources for Service members and their families in offices and clinics across the installation
Conduct outreach with the families of new recruits while they are in basic training to provide support and information for those families
Offer peer support programs for families whose Service members are experiencing emotional distress
Implications for Policy Makers
Recommend the screening of new recruits for previous mental health concerns
Encourage Service members with a history of suicidal behavior to participate in programs to support their wellbeing and fitness for duty
Encourage the development and continuation of programs that can promote resilience in Service members, their partners, and children
Methods
New Army recruits attending Basic Combat Training at three installations in 2011-2012 were invited to participate.
Ninety-four percent of the approached military personnel consented and completed the questionnaire.
Soldiers completed a questionnaire with measures of suicidal behavior and a computerized psychiatric diagnostic interview.
Soldiers also consented to have their Army and DoD administrative records accessed and linked to their responses.
Participants
A total of 38,507 new Army recruits participated.
No information on participants' race/ethnicity, gender, or age was presented.
No data on previous mental health services or treatment were presented.
Limitations
The sample was entirely comprised of Army recruits; the findings may not apply to other service branches or Soldiers who have longer service records.
The measures were self-reported and may be biased; bias could also stem from fears about how honest reporting might impact their career.
Only a small range of mental disorders was assessed and personality disorders (not assessed) may be related to suicidal behavior.
The study was correlational and causal conclusions are not appropriate.
Avenues for Future Research
Examine the efficacy of early interventions for mental disorders among Army recruits to prevent suicide attempts
Gather data on Service members who attempt suicide in order to identify risk factors
Replicate this study with Service members from other branches
Focus
Army
Target Population
Population Focus
Military Branch
Military Component
Abstract
We examined the associations between mental disorders and suicidal behavior (ideation, plans, and attempts) among new soldiers using data from the New Soldier Study (NSS) component of the Army Study to Assess Risk and Resilience in Service members (Army STARRS; N = 38,507). Most new soldiers with a pre-enlistment history of suicide attempt reported a prior mental disorder (59.0%). Each disorder examined was associated with increased odds of suicidal behavior (ORs = 2.6–8.6). Only PTSD and disorders characterized by irritability and impulsive/aggressive behavior (i.e., bipolar disorder, conduct disorder, oppositional defiant disorder, and attention-deficit/hyperactivity disorder) predicted unplanned attempts among ideators. Mental disorders are important predictors of pre-enlistment suicidal behavior among new soldiers and should figure prominently in suicide screening and prevention efforts.
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