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Study: Higher suicide risk linked to deployment

Mar. 4, 2014 - 03:28PM   |  
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A massive Army-funded review of the mental health and resilience of soldiers is starting to yield results, including a study published Monday that links increased suicide rates among service members to deployment — a direct contradiction of a 2013 Pentagon study that found no association between the two.

Separate articles published Monday online in JAMA Psychiatry found that deployment factors may correlate to increased suicides, as do suicide attempts that take place before deployments and pre- and post-enlistment psychiatric disorders.

According to the studies, one in five Army soldiers enter the service with a psychiatric disorder, and nearly half of all soldiers who tried suicide first attempted it before enlisting.

“These findings have major implications for screening, assessment, recruitment and retention of volunteers seeking military enlistment,” noted Dr. Matthew Friedman, professor of psychiatry at Dartmouth’s Geisel School of Medicine, in an editorial addressing the findings.

The Army Study to Assess Risk and Resilience in Servicemembers — dubbed STARRS — focuses on 975,057 active-duty soldiers who served from 2004 to 2009, including 569 suicides and 1,331 accidental deaths.

The project, a joint effort between the service and the National Institutes of Mental Health, is considered the largest review of mental health risk and suicidal ideation ever conducted among military personnel.

Other findings:

■ There is no consistent association between suicide risk and accession waivers or stop-loss orders.

■ Marriage, while appearing to be a protective factor against suicide for civilians, does not appear to be so for troops, with married troops having a higher number of suicide attempts than nonmarried or previously married members. Authors say this finding may be “consistent with evidence of special marital stressors among military personnel.”

■ Deployed women are at disproportionately higher risk for suicide, as are soldiers with limited education and those demoted in the previous two years.

The major finding — that soldiers who deploy are at increased risk for suicide — contradicts a finding by researchers of the Millennium Cohort Study, who released a report in August concluding that suicide was not tied to deployment stress or combat exposure.

That study looked at surveys and records of more than 150,000 troops from all services and found, instead, that mental health disorders and alcohol abuse played more of a role, as they do in civilian suicides.

But in “Predictors of Suicide and Accident Death in Army STARRS,” researcher Michael Schoenbaum and others write that they found that “elevated suicide risk among currently and previously deployed solders differs from the finding of no association ... in the Millennium Cohort Study.”

Schoenbaum said this might be attributed to the fact that his study focuses only on the Army and on existing records, while the Millennium Cohort Study uses survey data with a low response rate.

“The possibility of bias ... is plausible based on prior research showing that people with emotional problems have low rates of participation in surveys,” Schoenbaum and others wrote.

In his editorial, Friedman said much can be learned from the findings, which also indicated that a quarter of active-duty, nondeployed solders have at least one or more psychiatric disorders, and 76 percent had at least one disorder before they enlisted.

“Given the likelihood that applicants who don’t disclose their prior psychiatric history will continue to be accepted into the Army, it is important to consider the best course of action when it is discovered,” Friedman wrote.

According to the studies, the lifetime prevalence of suicidal thoughts among solders was 13.9 percent; for planning, 5.3 percent; and for attempts, 2.4 percent.

Five mental disorders were highly associated with a suicide attempt after enlistment, including evidence of panic disorder, post-traumatic stress disorder or intermittent explosive disorder before enlistment, and depression and intermittent explosive disorder that develops after enlistment.

“These are only the first articles to come from the groundbreaking Army STARRS initiative,” Friedman said. “Future articles will hopefully provide finer-grained measurements and more in-depth analysis of the variables already mentioned, as well as new information on psychological, neurocognitive, social, biological and genetic factors. They will also investigate the impact of intervention.”

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