Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-23T20:26:08.189Z Has data issue: false hasContentIssue false
  • English
  • Français

Occupational differences in US Army suicide rates

Published online by Cambridge University Press:  20 July 2015

R. C. Kessler ,
M. B. Stein ,
P. D. Bliese ,
E. J. Bromet ,
W. T. Chiu ,
K. L. Cox ,
L. J. Colpe ,
C. S. Fullerton ,
S. E. Gilman  and
M. J. Gruber
...Show all authors
R. C. Kessler*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
M. B. Stein
Affiliation:
Departments of Psychiatry and Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA VA San Diego Healthcare System, San Diego, CA, USA
P. D. Bliese
Affiliation:
Darla Moore School of Business, University of South Carolina, Columbia, SC, USA
E. J. Bromet
Affiliation:
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
W. T. Chiu
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
K. L. Cox
Affiliation:
US Army Public Health Command, Aberdeen Proving Ground, MD, USA
L. J. Colpe
Affiliation:
Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD, USA
C. S. Fullerton
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
S. E. Gilman
Affiliation:
Departments of Social and Behavioral Sciences, and Epidemiology, Harvard School of Public Health, Boston, MA, USA
M. J. Gruber
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
S. G. Heeringa
Affiliation:
Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
L. Lewandowski-Romps
Affiliation:
Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
A. Millikan-Bell
Affiliation:
US Army Public Health Command, Aberdeen Proving Ground, MD, USA
J. A. Naifeh
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
M. K. Nock
Affiliation:
Department of Psychology, Harvard University, Cambridge, MA, USA
M. V. Petukhova
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
A. J. Rosellini
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
N. A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
M. Schoenbaum
Affiliation:
Office of Science Policy, Planning and Communications, National Institute of Mental Health, Bethesda, MD, USA
A. M. Zaslavsky
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
R. J. Ursano
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
*
* Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Civilian suicide rates vary by occupation in ways related to occupational stress exposure. Comparable military research finds suicide rates elevated in combat arms occupations. However, no research has evaluated variation in this pattern by deployment history, the indicator of occupation stress widely considered responsible for the recent rise in the military suicide rate.

Method

The joint associations of Army occupation and deployment history in predicting suicides were analysed in an administrative dataset for the 729 337 male enlisted Regular Army soldiers in the US Army between 2004 and 2009.

Results

There were 496 suicides over the study period (22.4/100 000 person-years). Only two occupational categories, both in combat arms, had significantly elevated suicide rates: infantrymen (37.2/100 000 person-years) and combat engineers (38.2/100 000 person-years). However, the suicide rates in these two categories were significantly lower when currently deployed (30.6/100 000 person-years) than never deployed or previously deployed (41.2–39.1/100 000 person-years), whereas the suicide rate of other soldiers was significantly higher when currently deployed and previously deployed (20.2–22.4/100 000 person-years) than never deployed (14.5/100 000 person-years), resulting in the adjusted suicide rate of infantrymen and combat engineers being most elevated when never deployed [odds ratio (OR) 2.9, 95% confidence interval (CI) 2.1–4.1], less so when previously deployed (OR 1.6, 95% CI 1.1–2.1), and not at all when currently deployed (OR 1.2, 95% CI 0.8–1.8). Adjustment for a differential ‘healthy warrior effect’ cannot explain this variation in the relative suicide rates of never-deployed infantrymen and combat engineers by deployment status.

Conclusions

Efforts are needed to elucidate the causal mechanisms underlying this interaction to guide preventive interventions for soldiers at high suicide risk.

Keywords

ArmyArmy STARRSdeploymentresiliency factorssuicide
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 15 , November 2015 , pp. 3293 - 3304
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Armed Forces Health Surveillance Center (2012). Deaths by suicide while on active duty, active and reserve components, U.S. Armed Forces, 1998–2011. Medical Surveillance Monthly Reports 19, 7–10.Google Scholar
Armed Forces Staff College (1991). Joint Staff Officer's Guide 1991 (ed. Armed Forces Staff College and Department of the Army). National Defense University, Armed Forces Staff College: Norfolk, VA.Google Scholar
Bachynski, KE, Canham-Chervak, M, Black, SA, Dada, EO, Millikan, AM, Jones, BH (2012). Mental health risk factors for suicides in the US Army, 2007–8. Injury Prevention 18, 405–412.Google Scholar
Belisle, JG, Wenke, JC, Krueger, CA (2013). Return-to-duty rates among US military combat-related amputees in the global war on terror: job description matters. Journal of Trauma and Acute Care Surgery 75, 279–286.CrossRefGoogle ScholarPubMed
Bell, NS, Harford, TC, Amoroso, PJ, Hollander, IE, Kay, AB (2010). Prior health care utilization patterns and suicide among U.S. Army soldiers. Suicide and Life-Threatening Behavior 40, 407–415.CrossRefGoogle ScholarPubMed
Black, SA, Gallaway, MS, Bell, MR, Ritchie, EC (2011). Prevalence and risk factors associated with suicides of Army soldiers 2001–2009. Military Psychology 23, 433.Google Scholar
Browning, SR, Westneat, SC, McKnight, RH (2008). Suicides among farmers in three southeastern states, 1990–1998. Journal of Agricultural Safety and Health 14, 461–472.Google Scholar
Bryan, CJ, Griffith, JH, Pace, BT, Hinkson, K, Bryan, AO, Clemans, TA, Imel, ZE (2015). Combat exposure and risk for suicidal thoughts and behaviors among military personnel and veterans: a systematic review and meta-analysis. Suicide and Life-Threatening Behavior. Published online 8 April 2015. doi:10.1111/sltb.12163.CrossRefGoogle ScholarPubMed
Carr, JR, Hoge, CW, Gardner, J, Potter, R (2004). Suicide surveillance in the U.S. Military – reporting and classification biases in rate calculations. Suicide and Life-Threatening Behavior 34, 233–241.CrossRefGoogle ScholarPubMed
Cornum, R, Matthews, MD, Seligman, ME (2011). Comprehensive soldier fitness: building resilience in a challenging institutional context. American Psychologist 66, 4–9.CrossRefGoogle Scholar
Garvey Wilson, AL, Messer, SC, Hoge, CW (2009). U.S. military mental health care utilization and attrition prior to the wars in Iraq and Afghanistan. Social Psychiatry and Psychiatric Epidemiology 44, 473–481.CrossRefGoogle Scholar
Gilman, SE, Bromet, EJ, Cox, KL, Colpe, LJ, Fullerton, CS, Gruber, MJ, Heeringa, SG, Lewandowski-Romps, L, Millikan-Bell, AM, Naifeh, JA, Nock, MK, Petukhova, MV, Sampson, NA, Schoenbaum, M, Stein, MB, Ursano, RJ, Wessely, S, Zaslavsky, AM, Kessler, RC (2014). Sociodemographic and career history predictors of suicide mortality in the United States Army 2004–2009. Psychological Medicine 44, 2579–2592.CrossRefGoogle ScholarPubMed
Gubata, ME, Piccirillo, AL, Packnett, ER, Cowan, DN (2013). Military occupation and deployment: descriptive epidemiology of active duty U.S. Army men evaluated for a disability discharge. Military Medicine 178, 708–714.CrossRefGoogle ScholarPubMed
Hanigan, IC, Butler, CD, Kokic, PN, Hutchinson, MF (2012). Suicide and drought in New South Wales, Australia, 1970–2007. Proceedings of the National Academy of Sciences of the United States of America 109, 13950–13955.Google Scholar
Hawton, K, Clements, A, Sakarovitch, C, Simkin, S, Deeks, JJ (2001). Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979–1995. Journal of Epidemiology and Community Health 55, 296–300.Google Scholar
Hawton, K, Vislisel, L (1999). Suicide in nurses. Suicide and Life-Threatening Behavior 29, 86–95.CrossRefGoogle ScholarPubMed
Helmkamp, JC (1996). Occupation and suicide among males in the US Armed Forces. Annals of Epidemiology 6, 83–88.Google Scholar
Hernan, MA, Robins, JM (2006). Estimating causal effects from epidemiological data. Journal of Epidemiology and Community Health 60, 578–586.Google Scholar
Hoge, CW, Warner, CH, Castro, CA (2014). Mental health and the army. JAMA Psychiatry 71, 965–966.Google Scholar
Huguet, N, Kaplan, MS, McFarland, BH (2014). The effects of misclassification biases on veteran suicide rate estimates. American Journal of Public Health 104, 151–155.Google Scholar
Hyman, J, Ireland, R, Frost, L, Cottrell, L (2012). Suicide incidence and risk factors in an active duty US military population. American Journal of Public Health 102 (Suppl. 1), S138–S146.Google Scholar
Kessler, RC, Colpe, LJ, Fullerton, CS, Gebler, N, Naifeh, JA, Nock, MK, Sampson, NA, Schoenbaum, M, Zaslavsky, AM, Stein, MB, Ursano, RJ, Heeringa, SG (2013). Design of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). International Journal of Methods in Psychiatric Research 22, 267–275.CrossRefGoogle ScholarPubMed
Kirin, SJ, Winkler, JD (1992). The Army Military Occupational Specialty Database. RAND Corporation: Santa Monica, CA.Google Scholar
Kleykamp, MA (2006). College, jobs, or the military? Enlistment during a time of war. Social Science Quarterly 87, 272–290.CrossRefGoogle Scholar
Larson, GE, Highfill-McRoy, RM, Booth-Kewley, S (2008). Psychiatric diagnoses in historic and contemporary military cohorts: combat deployment and the healthy warrior effect. American Journal of Epidemiology 167, 1269–1276.CrossRefGoogle ScholarPubMed
Layne, M, Naftel, S, Thie, HJ, Kawata, JH (2001). Military Occupational Specialties: Change and Consolidation. RAND Corporation: Santa Monica, CA.Google Scholar
LeardMann, CA, Powell, TM, Smith, TC, Bell, MR, Smith, B, Boyko, EJ, Hooper, TI, Gackstetter, GD, Ghamsary, M, Hoge, CW (2013). Risk factors associated with suicide in current and former US military personnel. Journal of the American Medical Association 310, 496–506.CrossRefGoogle ScholarPubMed
Lindstrom, KE, Smith, TC, Wells, TS, Wang, LZ, Smith, B, Reed, RJ, Goldfinger, WE, Ryan, MA (2006). The mental health of U.S. military women in combat support occupations. Journal of Women's Health 15, 162–172.CrossRefGoogle ScholarPubMed
Maclean, A, Parsons, NL (2010). Unequal risk: combat occupations in the volunteer military. Sociological Perspectives: Official Publication of the Pacific Sociological Association 53, iii–iv.CrossRefGoogle ScholarPubMed
Montes, KS, Weatherly, JN (2014). The relationship between personality traits and military enlistment: an exploratory study. Military Behavioral Health 2, 98–104.Google Scholar
Morey, LC, Lowmaster, SE, Coldren, RL, Kelly, MP, Parish, RV, Russell, ML (2011). Personality Assessment Inventory profiles of deployed combat troops: an empirical investigation of normative performance. Psychological Assessment 23, 456–462.CrossRefGoogle ScholarPubMed
Neria, Y, Solomon, Z, Ginzburg, K, Dekel, R (2000). Sensation seeking, wartime performance, and long-term adjustment among Israeli war veterans. Personality and Individual Differences 29, 921–932.CrossRefGoogle Scholar
Niebuhr, DW, Gubata, ME, Oetting, AA, Weber, NS, Feng, X, Cowan, DN (2013). Personality Assessment Questionnaire as a pre-accession screen for risk of mental disorders and early attrition in U. S. Army recruits. Psychological Services 10, 378–385.CrossRefGoogle ScholarPubMed
Niebuhr, DW, Krampf, RL, Mayo, JA, Blandford, CD, Levin, LI, Cowan, DN (2011). Risk factors for disability retirement among healthy adults joining the U.S. Army. Military Medicine 176, 170–175.CrossRefGoogle ScholarPubMed
Nock, MK, Deming, CA, Fullerton, CS, Gilman, SE, Goldenberg, M, Kessler, RC, McCarroll, JE, McLaughlin, KA, Peterson, C, Schoenbaum, M, Stanley, B, Ursano, RJ (2013). Suicide among soldiers: a review of psychosocial risk and protective factors. Psychiatry 76, 97–125.Google Scholar
Parmak, M, Mylle, JJ, Euwema, MC (2014). Sensation seeking and perceived need for structure moderate soldiers’ well-being before and after operational deployment. Military Behavioral Health 2, 75–81.CrossRefGoogle Scholar
Peterson, C, Park, N, Castro, CA (2011). Assessment for the U.S. Army Comprehensive Soldier Fitness program: the Global Assessment Tool. American Psychologist 66, 10–18.CrossRefGoogle ScholarPubMed
Reger, MA, Smolenski, DJ, Skopp, NA, Metzger-Abamukang, MJ, Kang, HK, Bullman, TA, Perdue, S, Gahm, GA (2015). Risk of suicide among US Military service members following Operation Enduring Freedom or Operation Iraqi Freedom deployment and separation from the US Military. JAMA Psychiatry 72, 561–569.Google Scholar
SAS Institute Inc. (2010). SAS/STATR Software. SAS Institute Inc.: Cary, NC.Google Scholar
Schlesselman, JJ (1982). Case–Control Studies: Design, Conduct, Analysis. Oxford University Press: New York.Google Scholar
Schoenbaum, M, Kessler, RC, Gilman, SE, Colpe, LJ, Heeringa, SG, Stein, MB, Ursano, RJ, Cox, KL (2014). Predictors of suicide and accident death in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS): results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). JAMA Psychiatry 71, 493–503.Google Scholar
Street, AE, Gilman, SE, Rosellini, AJ, Stein, MB, Bromet, EJ, Cox, KL, Colpe, LJ, Fullerton, CS, Gruber, MJ, Heeringa, SG, Lewandowski-Romps, L, Little, RJA, Naifeh, JA, Nock, MK, Sampson, NA, Schoenbaum, MA, Ursano, RJ, Zaslavsky, AM, Kessler, RC (2015). Understanding the elevated suicide risk of female soldiers during deployments. Psychological Medicine 45, 717–726.Google Scholar
Trofimovich, L, Reger, MA, Luxton, DD, Oetjen-Gerdes, LA (2013). Suicide risk by military occupation in the DoD active component population. Suicide and Life-Threatening Behavior 43, 274–278.Google Scholar
Ursano, RJ, Colpe, LJ, Heeringa, SG, Kessler, RC, Schoenbaum, M, Stein, MB (2014). The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Psychiatry 77, 107–119.CrossRefGoogle ScholarPubMed
US Army (2015). Careers & Jobs (http://www.goarmy.com/careers-and-jobs/browse-career-and-job-categories.html). Accessed April 2015.Google Scholar
Willett, JB, Singer, JD (1993). Investigating onset, cessation, relapse, and recovery: why you should, and how you can, use discrete-time survival analysis to examine event occurrence. Journal of Consulting and Clinical Psychology 61, 952–965.Google Scholar
Wilson, J, Jones, M, Fear, NT, Hull, L, Hotopf, M, Wessely, S, Rona, RJ (2009). Is previous psychological health associated with the likelihood of Iraq War deployment? An investigation of the “healthy warrior effect”. American Journal of Epidemiology 169, 1362–1369.Google Scholar
Yip, PS, Caine, E, Yousuf, S, Chang, SS, Wu, KC, Chen, YY (2012). Means restriction for suicide prevention. Lancet 379, 2393–2399.Google Scholar