Time-varying associations of suicide with deployments, mental health conditions, and stressful life events among current and former US military personnel: a retrospective multivariate analysis
Abstract
Background US military suicides have increased substantially over the past decade and currently account for almost 20% of all military deaths. We investigated the associations of a comprehensive set of time-varying risk factors with suicides among current and former military service members. Methods We did a retrospective multivariate analysis of all US military personnel between 2001 and 2011 (n=110 035 573 person-quarter-years, representing 3 795 823 service members). Outcome was death by suicide, either during service or post-separation. We used Cox proportional hazard models at the person-quarter level to examine associations of deployment, mental disorders, history of unlawful activity, stressful life events, and other demographic and service factors with death by suicide. Findings The strongest predictors of death by suicide were current and past diagnoses of self-inflicted injuries, major depression, bipolar disorder, substance use disorder, and other mental health conditions (compared with service members with no history of diagnoses, the hazard ratio [HR] ranged from 1·4 [95% CI 1·14-1·72] to 8·34 [6·71-10·37]). Compared with service members who were never deployed, hazard rates of suicide (which represent the probability of death by suicide in a specific quarter given that the individual was alive in the previous quarter) were lower among the currently deployed (HR 0·50, 95% CI 0·40-0·61) but significantly higher in the quarters following first deployment (HR 1·51 [1·17-1·96] if deployed in the previous three quarters; 1·14 [1·06-1·23] if deployed four or more quarters ago). The hazard rate of suicide increased within the first year of separation from the military (HR 2·49, 95% CI 2·12-2·91), and remained high for those who had separated from the military 6 or more years ago (HR 1·63, 1·45-1·82). Interpretation The increased hazard rate of death by suicide for military personnel varies by time since exposure to deployment, mental health diagnoses, and other stressful life events. Continued monitoring is especially needed for these high-risk individuals. Additional information should be gathered to address the persistently raised risk of suicide among service members after separation. Funding Partly funded by the Naval Research Program.
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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 Shen et al. 2016
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- Authors
- Shen, Y.-C., Cunha, J. M., & Williams, T. V.
- Affiliations
- National Bureau of Economic Research (US)
- Naval Postgraduate School (US)
- Defense Health Agency (US)
- Corresponding author
- Shen, Yu-Chu
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2016-11
- Volume
- 3
- Issue
- 11
- Pages
- 1039-1048
- ISSN
- 2215-0366 (ISSN-L)
- OpenAlex
- W2527841520
- Cited by
- 102
- References
- 10
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 20 · 2023: 13 · 2022: 8 · 2021: 10 · 2020: 10 · 2019: 6 · 2018: 10 · 2017: 7 · 2016: 1
- FWCI
- 10.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Harvard University
- Defense Technical Information Center
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Performance
- Keywords
- military suicide, suicide risk factors, military deployment, mental illness, life events, substance use disorders, major depressive disorder, bipolar disorder, self-harm, former military personnel, US military personnel, military mental health services, suicide prevention policy, suicide prevention training
- MeSH terms
- Mental Disorders, Humans, Life Change Events, Military Personnel, Retrospective Studies, Risk Factors, Suicide, Time Factors, United States, Multivariate Analysis
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