Thursday, August 30, 2018

Soldiers Who Attempt Suicide Often Have No Prior Mental Health Diagnosis

More than one-third of enlisted U.S. soldiers who attempted suicide (36%) had no previous mental health diagnosis, according to an study published yesterday in JAMA Psychiatry.

“It is likely such soldiers had undetected mental disorders,” wrote Robert J. Ursano, M.D., director of the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences, and colleagues. Many factors may contribute to mental health problems going undiagnosed, including soldiers not perceiving a need for treatment or seeking help, they wrote.

Ursano and colleagues studied administrative data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), including records of 9,650 enlisted Army soldiers who had attempted suicide to pinpoint risk factors among those without a previous mental health diagnosis. The authors examined event report records, as well as army personnel, medical, legal, and family services records for soldiers who attempted suicide and compared them with soldiers with no history of suicidality or death.

More than 3,500 soldiers with a documented suicide attempt did not have a previous mental health diagnosis. Among these soldiers, those in the first year of service were most likely to attempt suicide (odds ratio [OR]=6). Among the other variables examined, suicide risk was also highest among soldiers with physical health care issues: inpatient hospitalizations (OR=3.8), eight or more outpatient visits in the past two months (OR=3.3), or past-month injury related outpatient care (OR=3.0). Soldiers with family violence, too, were 2.9 times more likely to attempt suicide.

Other significant risk factors for suicide attempt among soldiers with no prior mental health diagnosis included female sex (OR=2.6), previous deployment (OR=2.4), major violent crime perpetration (OR=2.0), or less than high school education (OR=1.9).

Most of these risk factors were also associated with suicide attempts among soldiers with a previous mental health diagnosis, although the strength of the associations differed. In both groups—soldiers with and without a history of mental health diagnosis—the odds of suicide attempt were higher among soldiers who were female, younger, non-Hispanic white, less educated, in their first four years of service, not currently deployed, with a delayed promotion or demotion, or an occupation of combat medic or combat arms.

“Interactions with medical, legal, and family services systems create assessment and prevention opportunities for soldiers with previously undetected suicide attempt risk,” the authors wrote. “Ensuring routine assessment of psychological distress and suicide risk during all encounters can help identify at-risk soldiers who are unknown to the mental health care system.”

For related information, see the Psychiatric News article “STARRS Findings Shed More Light on Army Suicides.”

(Image: iStock/MivPiv)


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