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Prevalence and Correlates of Suicidal Behavior Among Soldiers: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

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Nock, Matthew K., Stein, Murray B., Heeringa, Steven G., Ursano, Robert J., Colpe, Lisa J., Fullerton, Carol S., Hwang, Irving, Naifeh, James A. +4 more·2014·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2014.30PMC PMC4100464
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Abstract

IMPORTANCE: The suicide rate among US Army soldiers has increased substantially in recent years. OBJECTIVES: To estimate the lifetime prevalence and sociodemographic, Army career, and psychiatric predictors of suicidal behaviors among nondeployed US Army soldiers. DESIGN, SETTING, AND PARTICIPANTS: A representative cross-sectional survey of 5428 nondeployed soldiers participating in a group self-administered survey. MAIN OUTCOMES AND MEASURES: Lifetime suicidal ideation, suicide plans, and suicide attempts. RESULTS: The lifetime prevalence estimates of suicidal ideation, suicide plans, and suicide attempts are 13.9%, 5.3%, and 2.4%. Most reported cases (47.0%-58.2%) had pre-enlistment onsets. Pre-enlistment onset rates were lower than in a prior national civilian survey (with imputed/simulated age at enlistment), whereas post-enlistment onsets of ideation and plans were higher, and post-enlistment first attempts were equivalent to civilian rates. Most reported onsets of plans and attempts among ideators (58.3%-63.3%) occur within the year of onset of ideation. Post-enlistment attempts are positively related to being a woman (with an odds ratio [OR] of 3.3 [95% CI, 1.5-7.5]), lower rank (OR = 5.8 [95% CI, 1.8-18.1]), and previously deployed (OR = 2.4-3.7) and are negatively related to being unmarried (OR = 0.1-0.8) and assigned to Special Operations Command (OR = 0.0 [95% CI, 0.0-0.0]). Five mental disorders predict post-enlistment first suicide attempts in multivariate analysis: pre-enlistment panic disorder (OR = 0.1 [95% CI, 0.0-0.8]), pre-enlistment posttraumatic stress disorder (OR = 0.1 [95% CI, 0.0-0.7]), post-enlistment depression (OR = 3.8 [95% CI, 1.2-11.6]), and both pre- and post-enlistment intermittent explosive disorder (OR = 3.7-3.8). Four of these 5 ORs (posttraumatic stress disorder is the exception) predict ideation, whereas only post-enlistment intermittent explosive disorder predicts attempts among ideators. The population-attributable risk proportions of lifetime mental disorders predicting post-enlistment suicide attempts are 31.3% for pre-enlistment onset disorders, 41.2% for post-enlistment onset disorders, and 59.9% for all disorders. CONCLUSIONS AND RELEVANCE: The fact that approximately one-third of post-enlistment suicide attempts are associated with pre-enlistment mental disorders suggests that pre-enlistment mental disorders might be targets for early screening and intervention. The possibility of higher fatality rates among Army suicide attempts than among civilian suicide attempts highlights the potential importance of means control (ie, restricting access to lethal means [such as firearms]) as a suicide prevention strategy.

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  • Suicide, homelessness and substance abuse, among other adverse outcomes, have been associated with major depression or generalized anxiety disorder and are concerns for active military personnel and/or veterans.

    “Suicide, homelessness and substance abuse, among other adverse outcomes, have been associated with major depression or generalized anxiety disorder and are concerns for active military personnel and/or veterans (Nock et al. 2014; Hoggatt et al. 2015; Tsai & Rosenheck 2015).”

    From Childhood adversity, adult stress, and the risk of major depression or generalized anxiety disorder in US soldiers: a test of the stress sensitization hypothesis (2017) · cites this paper as Nock et al. 2014

    The Results and Discussion (page not available in our copy) associate post-enlistment major depressive disorder with suicidal ideation and first suicide attempts among soldiers. The paper measures generalized anxiety disorder and substance use disorders, but the passages do not establish the claimed associations with generalized anxiety disorder, homelessness, or substance abuse as an adverse outcome of depression or anxiety. (LLM, conf=0.88)

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  • There is an increased risk of suicide and suicidal behaviors associated with major depression in the military.

    “Further, there is an increased risk of suicide (LeardMann et al. 2013; Shen et al. 2016) and suicidal behaviors (Nock et al. 2014) associated with major depression in the military.”

    From Childhood adversity, adult stress, and the risk of major depression or generalized anxiety disorder in US soldiers: a test of the stress sensitization hypothesis (2017) · cites this paper as Nock et al. 2014

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  1. [22]Rothman K Greenland S Modern Epidemiology 2 Philadelphia, PA Lippincott Williams & Wilkins 1998

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Authors
Nock, M. K., Stein, M. B., Heeringa, S. G., Ursano, R. J., Colpe, L. J., Fullerton, C. S., Hwang, I., Naifeh, J. A., Sampson, N. A., Schoenbaum, M., Zaslavsky, A. M., & Kessler, R. C.
Affiliations
  • Harvard University (US)
  • University of California San Diego (US)
  • University of Michigan (US)
  • Uniformed Services University of the Health Sciences (US)
  • National Institute of Mental Health (US)
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2014-05-01
Volume
71
Issue
5
Pages
514
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2014.30
PMC
PMC4100464
OpenAlex
W2089436312
Cited by
329
References
42
Citations by year
2026: 6 · 2025: 14 · 2024: 5 · 2023: 15 · 2022: 19 · 2021: 30 · 2020: 32 · 2019: 33 · 2018: 35 · 2017: 39 · 2016: 42 · 2015: 39 · 2014: 19
FWCI
54.83
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
  • Harvard University
  • Uniformed Services University of the Health Sciences
  • University of California, San Diego
  • Veterans Affairs San Diego Healthcare System
  • National Institute of Mental Health (U01MH087981)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
suicidal behavior, suicidal ideation, suicide planning, suicide attempts, U.S. Army soldiers, military personnel, lifetime prevalence, depression, post-traumatic stress disorder, panic disorder, intermittent explosive disorder, psychiatric comorbidity, sociodemographic predictors, military deployment, suicide prevention, suicide prevention programs
MeSH terms
Adult, Mental Disorders, Female, Health Surveys, Humans, Internal-External Control, Male, Military Personnel, Risk Factors, Sex Factors, Statistics as Topic, Suicide, Suicide, Attempted, Age of Onset, Risk Assessment, Iraq War, 2003-2011, Resilience, Psychological, Young Adult, Afghan Campaign 2001-, Suicidal Ideation

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