Psychological Medicine

Original Articles

Sociodemographic and career history predictors of suicide mortality in the United States Army 2004–2009

S. E. Gilmana1, E. J. Brometa2, K. L. Coxa3, L. J. Colpea4, C. S. Fullertona5, M. J. Grubera6, S. G. Heeringaa7, L. Lewandowski-Rompsa7, A. M. Millikan-Bella3, J. A. Naifeha5, M. K. Nocka8, M. V. Petukhovaa6, N. A. Sampsona6, M. Schoenbauma9, M. B. Steina10a11, R. J. Ursanoa5, S. Wesselya12, A. M. Zaslavskya6, R. C. Kesslera6 c1 and on behalf of the Army STARRS Collaborators

a1 Departments of Social and Behavioral Sciences, and Epidemiology, Harvard School of Public Health, Boston, MA, USA

a2 Department of Psychiatry and Behavioral Science, Stony Brook School of Medicine, Stony Brook, NY, USA

a3 US Army Public Health Command, Aberdeen Proving Ground, MD, USA

a4 Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD, USA

a5 Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA

a6 Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

a7 Institute for Social Research, University of Michigan, Ann Arbor, MI, USA

a8 Department of Psychology, Harvard University, Cambridge, MA, USA

a9 Office of Science Policy, Planning and Communications, National Institute of Mental Health, Bethesda, MD, USA

a10 Departments of Psychiatry and Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA

a11 VA San Diego Healthcare System, San Diego, CA, USA

a12 King's Centre for Military Health Research, King's College London, London, UK

Abstract

Background The US Army suicide rate has increased sharply in recent years. Identifying significant predictors of Army suicides in Army and Department of Defense (DoD) administrative records might help focus prevention efforts and guide intervention content. Previous studies of administrative data, although documenting significant predictors, were based on limited samples and models. A career history perspective is used here to develop more textured models.

Method The analysis was carried out as part of the Historical Administrative Data Study (HADS) of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). De-identified data were combined across numerous Army and DoD administrative data systems for all Regular Army soldiers on active duty in 2004–2009. Multivariate associations of sociodemographics and Army career variables with suicide were examined in subgroups defined by time in service, rank and deployment history.

Results Several novel results were found that could have intervention implications. The most notable of these were significantly elevated suicide rates (69.6–80.0 suicides per 100 000 person-years compared with 18.5 suicides per 100 000 person-years in the total Army) among enlisted soldiers deployed either during their first year of service or with less than expected (based on time in service) junior enlisted rank; a substantially greater rise in suicide among women than men during deployment; and a protective effect of marriage against suicide only during deployment.

Conclusions A career history approach produces several actionable insights missed in less textured analyses of administrative data predictors. Expansion of analyses to a richer set of predictors might help refine understanding of intervention implications.

(Received November 15 2013)

(Revised January 07 2014)

(Accepted January 11 2014)

(Online publication February 19 2014)

Key words

  • Army;
  • Army STARRS;
  • epidemiology;
  • military;
  • risk factors;
  • suicide

Correspondence

c1 Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. (Email: ncs@hcp.med.harvard.edu)

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