A study published in JAMA Psychiatry on Wednesday, May 25th looked into the timing and risk factors associated with US soldier suicide patterns among soldiers who were currently deployed, previously deployed or were never deployed from 2004-2009. Results revealed that those who were in their second month of service and those who had never been deployed were at a higher suicidal risk than others.

Close investigation of the timing and risk factors revealed that 40.4 % of soldiers who had never been deployed attempted suicide, with cases ranging up to 5984 in number. Most of these suicide attempts were made in the second month of service. The risk in this particular group increased earlier on in service and was then followed by a decline. It then continued to increase at a gradual and constant rate through the end of the first year of service.

The researchers explained how this time period is considered the most stressful since it involves rigorous training and army acculturation. This could be due to factors such as expansion of the army during war or anticipated deployments or perhaps simply the stress of training.

For those who were on their first deployment, the sixth month saw the highest number of suicide attempts whereas the fifth month was the riskiest for previously deployed soldiers. This finding is consistent with previous research which has shown that mental health concerns are at an increased risk from the third to sixth month post deployment as opposed to immediately on return.

 Overdose was the most common method to attempt suicide. However, the use of firearms has also been observed amongst currently deployed soldiers at 13.6 %  and previously deployed soldiers at 3.9% respectively.

The association between mental health disorder and suicide attempts was also well established. Women were more likely to attempt suicide in their first two years of service and were mostly diagnosed with a mental health disorder one month prior to attempting suicide. During this time, 75% of service members were in contact with the health care system. The most frequently diagnosed disorders were depression, Post Traumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) for soldiers and previously deployed soldiers had a higher risk of suicide attempts if they were screened positive for depression. Soldiers who were never deployed and who suffered from depression, PTSD or SUD in the previous month were at the greatest risk.

The main limitations of the study were that the suicide attempts were only limited to events recorded by the health care system. Changes in policy and procedures as well as coding errors could have arisen due to this and therefore, this study does not give us an entirely clear account of the real picture. Moreover, the findings are only from the years 2004-2009 examining only a limited set of predictors. The post deployment health findings may not be an accurate representation of all the previously deployed soldiers, since the data was limited to soldiers who had been deployed only once and completed both assessments. Lastly, differences that were found amongst deployed soldiers do not provide us with evidence of internal person changes which might occur with time, as these groups are unaffected by the non random nature of deployment and army attrition. Nonetheless, the results do give us an insight into the situation and the possibility of the risk factors and timing of the suicide attempts.

Suicide attempts are increasing every year and occurring at a faster rate than even heart attacks. Thus, a comprehensive study was needed to formulate target interventions and to come up with effective prevention methods.

A total of 163,178 soldiers were studied out of which 9650 had attempted suicide. Out of the 9650 soldiers, 83.6% were men and 68.4% were younger than 30 years of age. Nearly half of them were Hispanic white and currently married and 76.5 % were only high school educated. Data was analyzed using a discrete time survival framework with person-month as the unit of analysis.

The study was a component of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) Historical Administrative Data Study.

Army STARRS is modeled after the popular Framingham Heart Study, which involved the tracking of participants in 1948 and established the basis for recommendations to maintain a healthy heart.

Dr Robert J Ursano, the lead author of the study and chair of the department of Psychiatry at USU says, “This is historical data – it is an army at war. The findings may or may not apply to an army not at war.” He concludes by saying that “It is a good screening program and adds to our ability to predict risk.”

However, further research is required to examine the possible reasons why there were sex differences as well as occupational differences amongst those deployed. Moreover, the role of sexual assault or harassment including sex differences in response to deployment related stressors would contribute to a better understanding of the entire situation.