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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)
Open accessAbstract
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 (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
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“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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Self-citationCross-national prevalence and risk factors for suicidal ideation, plans and attempts
Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M., Beautrais, A., Bruffaerts, R., Chiu, W. T., de Girolamo, G., Gluzman, S., et al. (2008) · British Journal of Psychiatry · doi:10.1192/bjp.bp.107.040113 · Cited by 2,654
Self-citationPrevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative
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Self-citationNock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013) · JAMA Psychiatry · doi:10.1001/2013.jamapsychiatry.55 · Cited by 1,666
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Epidemiology of suicide and the psychiatric perspective
Bachmann, S. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15071425 · Cited by 1,377
Chu, C., Buchman-Schmitt, J. M., Stanley, I. H., Hom, M. A., Tucker, R. P., Hagan, C. R., Rogers, M. L., Podlogar, M. C., Chiurliza, B., Ringer, F. B., et al. (2017) · Psychological Bulletin · doi:10.1037/bul0000123 · Cited by 1,231
“In this regard, the interpersonal theory is the first theory of suicide positioned within what would later be termed the ideation-to-action framework (Klonsky & May, 2014; Klonsky et al., 2016; Nock et al., 2014).”
BackgroundThe Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)
Ursano, R. J., Colpe, L. J., Heeringa, S. G., Kessler, R. C., Schoenbaum, M., Stein, M. B., & collaborators, O. B. O. T. A. S. (2014) · Psychiatry · doi:10.1521/psyc.2014.77.2.107 · Cited by 283
Self-citationKrystal, J. H., Davis, L. L., Neylan, T. C., A. Raskind, M., Schnurr, P. P., Stein, M. B., Vessicchio, J., Shiner, B., Gleason, T. D., & Huang, G. D. (2017) · Biological Psychiatry · doi:10.1016/j.biopsych.2017.03.007 · Cited by 265
Self-citationMeyer, I. H., Russell, S. T., Hammack, P. L., Frost, D. M., & Wilson, B. D. M. (2021) · PLOS ONE · doi:10.1371/journal.pone.0246827 · Cited by 249
Metadata
- 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)
- 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
- green
- www.ncbi.nlm.nih.gov
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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