Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-25T08:32:45.687Z Has data issue: false hasContentIssue false
  • English
  • Français

Understanding the elevated suicide risk of female soldiers during deployments

Published online by Cambridge University Press:  31 October 2014

A. E. Street ,
S. E. Gilman ,
A. J. Rosellini ,
M. B. Stein ,
E. J. Bromet ,
K. L. Cox ,
L. J. Colpe ,
C. S. Fullerton ,
M. J. Gruber  and
S. G. Heeringa
...Show all authors
A. E. Street
Affiliation:
National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
S. E. Gilman
Affiliation:
Departments of Social and Behavioral Sciences, and Epidemiology, Harvard School of Public Health, Boston, MA, USA
A. J. Rosellini
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
E. J. Bromet
Affiliation:
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, 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:
Department of Psychiatry, Uniformed Services University School of Medicine, Center for the Study of Traumatic Stress, Bethesda, MD, 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
R. J. A. Little
Affiliation:
Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
J. A. Naifeh
Affiliation:
Department of Psychiatry, Uniformed Services University School of Medicine, Center for the Study of Traumatic Stress, Bethesda, MD, USA
M. K. Nock
Affiliation:
Department of Psychology, Harvard University, Cambridge, 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
R. J. Ursano
Affiliation:
Department of Psychiatry, Uniformed Services University School of Medicine, Center for the Study of Traumatic Stress, Bethesda, MD, USA
A. M. Zaslavsky
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
R. C. Kessler*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
*
*Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) has found that the proportional elevation in the US Army enlisted soldier suicide rate during deployment (compared with the never-deployed or previously deployed) is significantly higher among women than men, raising the possibility of gender differences in the adverse psychological effects of deployment.

Method

Person-month survival models based on a consolidated administrative database for active duty enlisted Regular Army soldiers in 2004–2009 (n = 975 057) were used to characterize the gender × deployment interaction predicting suicide. Four explanatory hypotheses were explored involving the proportion of females in each soldier's occupation, the proportion of same-gender soldiers in each soldier's unit, whether the soldier reported sexual assault victimization in the previous 12 months, and the soldier's pre-deployment history of treated mental/behavioral disorders.

Results

The suicide rate of currently deployed women (14.0/100 000 person-years) was 3.1–3.5 times the rates of other (i.e. never-deployed/previously deployed) women. The suicide rate of currently deployed men (22.6/100 000 person-years) was 0.9–1.2 times the rates of other men. The adjusted (for time trends, sociodemographics, and Army career variables) female:male odds ratio comparing the suicide rates of currently deployed v. other women v. men was 2.8 (95% confidence interval 1.1–6.8), became 2.4 after excluding soldiers with Direct Combat Arms occupations, and remained elevated (in the range 1.9–2.8) after adjusting for the hypothesized explanatory variables.

Conclusions

These results are valuable in excluding otherwise plausible hypotheses for the elevated suicide rate of deployed women and point to the importance of expanding future research on the psychological challenges of deployment for women.

Keywords

ArmyArmy STARRSepidemiologygendermilitaryrisk factorssuicide
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 4 , March 2015 , pp. 717 - 726
Copyright
Copyright © Cambridge University Press 2014 

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

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
Belik, SL, Stein, MB, Asmundson, GJ, Sareen, J (2009). Relation between traumatic events and suicide attempts in Canadian military personnel. Canadian Journal of Psychiatry 54, 93–104.Google Scholar
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.Google Scholar
Black, SA, Gallaway, M, Bell, MR, Ritchie, EC (2011). Prevalence and risk factors associated with suicides of Army soldiers 2001–2009. Military Psychology 23, 433–451.Google Scholar
Conner, KR, McCarthy, MD, Bajorska, A, Caine, ED, Tu, XM, Knox, KL (2012). Mood, anxiety, and substance-use disorders and suicide risk in a military population cohort. Suicide and Life-Threatening Behavior 42, 699–708.Google Scholar
Cumming, G (2014). The new statistics: why and how. Psychological Science 25, 7–29.Google Scholar
Defense Manpower Data Center (2014). Military Personnel (https://www.dmdc.osd.mil/appj/dwp/reports.do?category=reports&subCat=milActDutReg). Accessed July 2014.Google Scholar
Defense Manpower Data Center (2009). Contingency Tracking System Profile of Service Members Ever Deployed in Support of OEF/OIF from Sept. 2001–Oct. 2009, By Gender. Department of Defense: Washington, DC.Google Scholar
Department of Defense (2012). Sexual Assault Prevention and Response (SAPR) Program (DoD Instruction 6495.01). Department of Defense: Washington, DC.Google Scholar
Department of Defense (2013). Memorandum for Secretaries of the Military Departments Acting Under Secretary of Defense for Personnel and Readiness Chiefs of the Military Services: Elimination of the 1994 Direct Ground Combat Definition and Assignment Rule. Department of Defense: Washington, DC (http://www.defense.gov/news/WISRJointMemo.pdf). Accessed July 2014.Google Scholar
Department of the Army (1992). Army Regulation 600–13, Army Policy for the Assignment of Female Soldiers. Department of the Army: Washington, DC.Google Scholar
Department of the Army Office of the Surgeon General (2006). Mental Health Advisory Team (MHAT-IV) Operation Iraqi Freedom 05–07 Report: Final Report (www.combatreform.org/MHAT_IV_Report_17NOV06.pdf). Accessed October 2014.Google Scholar
Devries, K, Watts, C, Yoshihama, M, Kiss, L, Schraiber, LB, Deyessa, N, Heise, L, Durand, J, Mbwambo, J, Jansen, H, Berhane, Y, Ellsberg, M, Garcia-Moreno, C (2011). Violence against women is strongly associated with suicide attempts: evidence from the WHO multi-country study on women's health and domestic violence against women. Social Science and Medicine 73, 79–86.Google 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). Socio-demographic and career history predictors of suicide and suicide mortality in the United States Army 2004–2009. Psychological Medicine 44, 2579–2592.Google Scholar
Gradus, JL, Qin, P, Lincoln, AK, Miller, M, Lawler, E, Sorensen, HT, Lash, TL (2012). Sexual victimization and completed suicide among Danish female adults. Violence Against Women 18, 552–561.Google Scholar
Gradus, JL, Shipherd, JC, Suvak, MK, Giasson, HL, Miller, M (2013a). Suicide attempts and suicide among Marines: a decade of follow-up. Suicide and Life-Threatening Behavior 43, 39–49.Google Scholar
Gradus, JL, Street, AE, Suvak, MK, Resick, PA (2013b). Predictors of suicidal ideation in a gender-stratified sample of OEF/OIF veterans. Suicide and Life-Threatening Behavior 43, 574–588.Google Scholar
Hoge, CW, Clark, JC, Castro, CA (2007). Commentary: women in combat and the risk of post-traumatic stress disorder and depression. International Journal of Epidemiology 36, 327–329.Google Scholar
Ireland, RR, Kress, AM, Frost, LZ (2012). Association between mental health conditions diagnosed during initial eligibility for military health care benefits and subsequent deployment, attrition, and death by suicide among active duty service members. Military Medicine 177, 1149–1156.Google Scholar
Kang, HK, Bullman, TA (2008). Risk of suicide among US veterans after returning from the Iraq or Afghanistan war zones. JAMA 300, 652–653.Google Scholar
Kessler, RC, Chiu, WT, Demler, O, Merikangas, KR, Walters, EE (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617–627.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.Google Scholar
Kessler, RC, Heeringa, SG, Stein, MB, Colpe, LJ, Fullerton, CS, Hwang, I, Naifeh, JA, Nock, MK, Petukhova, M, Sampson, NA, Schoenbaum, M, Zaslavsky, AM, Ursano, RJ (2014). Thirty-day prevalence of DSM-IV mental disorders among nondeployed soldiers in the US Army: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). JAMA Psychiatry 71, 504–513.Google 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.Google Scholar
Leardmann, CA, Pietrucha, A, Magruder, KM, Smith, B, Murdoch, M, Jacobson, IG, Ryan, MA, Gackstetter, G, Smith, TC (2013a). Combat deployment is associated with sexual harassment or sexual assault in a large, female military cohort. Women's Health Issues 23, e215–e223.Google Scholar
LeardMann, CA, Powell, TM, Smith, TC, Bell, MR, Smith, B, Boyko, EJ, Hooper, TI, Gackstetter, GD, Ghamsary, M, Hoge, CW (2013b). Risk factors associated with suicide in current and former US military personnel. JAMA 310, 496–506.Google Scholar
Luxton, DD, Skopp, NA, Maguen, S (2010). Gender differences in depression and PTSD symptoms following combat exposure. Depression and Anxiety 27, 1027–1033.Google Scholar
Maguen, S, Luxton, DD, Skopp, NA, Gahm, GA, Reger, MA, Metzler, TJ, Marmar, CR (2011). Killing in combat, mental health symptoms, and suicidal ideation in Iraq war veterans. Journal of Anxiety Disorders 25, 563–567.Google Scholar
Mengeling, MA, Booth, BM, Torner, JC, Sadler, AG (2014). Reporting sexual assault in the military: who reports and why most servicewomen don't. American Journal of Preventive Medicine 47, 17–25.Google Scholar
Miller, M, Barber, C, White, RA, Azrael, D (2013). Firearms and suicide in the United States: is risk independent of underlying suicidal behavior? American Journal of Epidemiology 178, 946–955.Google Scholar
Miller, M, Hemenway, D (2008). Guns and suicide in the United States. New England Journal of Medicine 359, 989–991.10.1056/NEJMp0805923Google Scholar
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
Pietrzak, RH, Goldstein, MB, Malley, JC, Rivers, AJ, Johnson, DC, Southwick, SM (2010). Risk and protective factors associated with suicidal ideation in veterans of Operations Enduring Freedom and Iraqi Freedom. Journal of Affective Disorders 123, 102–107.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
Skopp, NA, Reger, MA, Reger, GM, Mishkind, MC, Raskind, M, Gahm, GA (2011). The role of intimate relationships, appraisals of military service, and gender on the development of posttraumatic stress symptoms following Iraq deployment. Journal of Traumatic Stress 24, 277–286.Google Scholar
Street, AE, Gradus, JL, Giasson, HL, Vogt, D, Resick, PA (2013). Gender differences among veterans deployed in support of the wars in Afghanistan and Iraq. Journal of General Internal Medicine 28 (Suppl. 2), S556–S562.Google Scholar
Street, AE, Gradus, JL, Stafford, J, Kelly, K (2007). Gender differences in experiences of sexual harassment: data from a male-dominated environment. Journal of Consulting and Clinical Psychology 75, 464–474.Google Scholar
Street, AE, Vogt, D, Dutra, L (2009). A new generation of women veterans: stressors faced by women deployed to Iraq and Afghanistan. Clinical Psychology Review 29, 685–694.Google Scholar
Turner, HA (1994). Gender and social support: taking the bad with the good? Sex Roles 30, 521–541.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.Google Scholar
Vogt, D, Smith, B, Elwy, R, Martin, J, Schultz, M, Drainoni, ML, Eisen, S (2011a). Predeployment, deployment, and postdeployment risk factors for posttraumatic stress symptomatology in female and male OEF/OIF veterans. Journal of Abnormal Psychology 120, 819–831.Google Scholar
Vogt, D, Vaughn, R, Glickman, ME, Schultz, M, Drainoni, ML, Elwy, R, Eisen, S (2011b). Gender differences in combat-related stressors and their association with postdeployment mental health in a nationally representative sample of U.S. OEF/OIF veterans. Journal of Abnormal Psychology 120, 797–806.Google Scholar
Vogt, DS, Pless, AP, King, LA, King, DW (2005). Deployment stressors, gender, and mental health outcomes among Gulf War I veterans. Journal of Traumatic Stress 18, 115–127.Google Scholar
Warner, CH, Appenzeller, GN, Parker, JR, Warner, CM, Hoge, CW (2011). Effectiveness of mental health screening and coordination of in-theater care prior to deployment to Iraq: a cohort study. American Journal of Psychiatry 168, 378–385.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