Lifetime history of exposure to a traumatic event and self-reported lifetime and current depression are predictive of recent suicide ideation in deployed soldiers, according to a new JAMA Network Open study published January 29, 2020. Researchers suggest that attention to deployment experiences that increase suicide ideation in soldiers with past trauma and major depressive disorder can assist clinicians and leadership in identifying and treating Soldiers at increased risk for suicide.
The study, "Factors associated with suicide ideation in US Army soldiers during deployment in Afghanistan," was conducted by the Uniformed Services University of the Health Sciences (USU) in collaboration with Harvard University, University of Michigan, University of California San Diego, and the VA San Diego Healthcare System. The researchers sought to identify socio-demographic characteristics, stressful events, and mental disorders associated with suicidal thoughts during deployment, as part of an ongoing effort to improve understanding of suicide in the U.S. Army. This study is unique in its assessment of Soldiers' self-report at mid-deployment, a period during which suicide attempt rates appear to peak according to previous research by these investigators. Although the study looked at Soldiers in the Army, these findings have implications for other services and the national issue of suicide.
The researchers surveyed 3,957 enlisted Soldiers (including Army National Guard and Army Reserve members) in Kuwait as they transitioned into and out of Afghanistan for mid-deployment leave in July 2012. Among these Soldiers, 3% reported past-year and 1.9% reported past 30-day suicide ideation. Soldiers who reported suicide ideation during deployment were more likely to make a subsequent suicide attempt.
Deployed Soldiers who reported suicide ideation within the past 30 days were more likely to be Caucasian, and reported exposure to a past bullying or sexual assault incident and/or non-combat-related trauma in their lifetimes. Further, in the past 12 months, those who reported suicide ideation were more likely to have experienced relationship or legal problems, combat trauma, assault or injury to themselves or another person, death or serious illness to a friend or family member, and met criteria for a major depressive disorder. Among Soldiers with suicide ideation, 44.2% had major depression in the past 30 days.
The study found that when all of the risk factors were considered together, white race/ethnicity, exposure to a lifetime non-combat trauma, and a history of major depressive disorder remained associated with suicide ideation in the past 30 days.
Importantly, mental health burden at mid-deployment is considerable, with 14% of Soldiers reporting a current mental disorder. This rate is particularly elevated among Soldiers with current suicide ideation, with 60% having at least one mental disorder. However, the substantial proportion of soldiers with suicide ideation who do not report a mental disorder (40%), suggests that specific outreach efforts for these at-risk soldiers who do not meet mental disorder criteria, perhaps due to underreported or subthreshold symptoms, can aid in identification of soldiers at risk of suicide.
The study is a rare examination of risk factors for suicide ideation among soldiers during their current deployment. Given that mid-deployment is identified as the highest risk period for soldiers in-theater, understanding and identifying risk factors for suicide ideation in soldiers during deployment may help target those who may transition from suicide ideation to attempt. This strategy allows for mobilizing military resources to help treat at-risk soldiers and prevent suicide attempts."
Dr. Robert Ursano, director of USU's Center for the Study of Traumatic Stress
The study was part of the Study to Assess Risk and Resilience in Servicemembers – Longitudinal Study (STARRS-LS), a research project led by Ursano, running from 2015 to 2020. The project is designed to provide actionable information to reduce suicide-related behavior, and other mental/behavioral health issues in the military. It also expands the work of Army STARRS, the largest research study of mental health risk and resilience ever conducted among Army personnel, running from 2009 through 2015.
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