Suicide Attempt Risk May Be Higher Among Soldiers in Army Units With History of Suicide Attempts

U.S. Army soldiers may be more likely to attempt suicide if others in their unit have made recent suicide attempts, according to a study published today in JAMA Psychiatry. The findings, which were based on analysis of data collected between 2004 and 2009, suggest that units with a history of suicide attempts may be important targets for preventive interventions.

“Units are the foundational structure of the U.S. Army,” Robert Ursano, M.D., of the Uniformed Services University of the Health Sciences in Bethesda, Md., and colleagues wrote. While injuries and deaths from combat and unintentional events are known to adversely affect the mental health of unit members, few studies have examined the influence of suicidal behavior on other unit members.

Ursano and colleagues used administrative data collected as part of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS) to identify the records of all active-duty, regular U.S. Army enlisted soldiers who attempted suicide from 2004 through 2009—at the height of the wars in Iraq and Afghanistan. Of the 9,512 enlisted soldiers who attempted suicide during this period, most were male (86.4%), 29 years or younger (68.4%), younger than 21 years when entering the Army (62.2%), white (59.8%), high school educated (76.6%), and married (54.8%).

The study revealed that soldiers were more likely to attempt suicide if assigned to a unit with one or more past-year suicide attempts, with odds increasing as the number of unit suicide attempts increased from one (odds ratio [OR], 1. 6) to five or more (OR, 3.9). Soldiers were twice as likely to attempt suicide if there were five or more past-year unit attempts than if there were no attempts (OR, 2.3). This association remained significant after adjusting for sociodemographic variables, age at entry into the Army, time in service, deployment status, occupation, and unit size. In contrast, unit deaths, including deaths from suicide, were not significantly associated with the risk of suicide attempt, the authors noted.

Ursano and colleagues noted that more research is needed to know whether the findings generalize to earlier and later periods of the Iraq and Afghanistan wars or to other U.S. military conflicts.

“The findings from this study certainly reflect actionable information, raising tantalizing questions about the influence of military social structure and leadership on suicide risk factors as well as the potential for contagion of suicidal behaviors within Army units,” Charles Hoge, M.D., Christopher Ivany, M.D., and Amy Adler, Ph.D., of Walter Reed Army Institute of Research and the Office of the Army Surgeon General wrote in a related editorial.

For related information, see Care of Military Service Members, Veterans, and Their Families and the Psychiatric Services article “Suicide Risk Assessment and Prevention: A Systematic Review Focusing on Veterans.”

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