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In-unit suicide attempts doubles risk in Army soldiers

Army soldiers in a unit with five or more suicide attempts in the past year were twice as likely to attempt suicide, compared with peers in units with no attempts.

“The suicide attempt rate among U.S. Army soldiers increased substantially during the Iraq and Afghanistan wars,” Robert J. Ursano, MD, of Uniformed Services University of the Health Sciences, and colleagues wrote. “Medically documented [suicide attempts] are more likely to occur among soldiers never or previously deployed (vs. currently deployed) and soldiers who are female, younger, non-Hispanic white, less educated, and in the early stages of army service, particularly the initial months of training. The risk of [suicide attempt] may also be influenced by events within a soldier’s army unit, including suicidal behavior of other unit members.”

To quantify the impact previous suicide attempts in a soldier’s unit has on risk for suicide attempt, researchers evaluated administrative data from the Army Study to Assess Risk and Resilience in Service members (STARRS) for all active-duty regular, enlisted U.S. Army soldiers who attempted suicide (n = 9,650) and an equal-probability sample of control person-months (n = 153,528).

The majority of the study cohort was male (86.4%), aged 29 years or younger (68.4%), aged younger than 21 years when entering the army (62.2%), white (59.8%), high school educated (76.6%), and currently married (54.8%).

Adjusted analysis indicated soldiers were more likely to attempt suicide if one or more suicide attempts occurred in their unit in the past year (ORs = 1.4-2.3; P < .001), with increasing odds if the number of in-unit attempts increased.

Soldiers in a unit with five or more past-year attempts were more than twice as likely to attempt suicide (OR = 2.3; 95% CI, 2.1-2.6), compared with soldiers in a unit with no previous attempts.

The association between previous unit suicide attempts and subsequent risk remained significant whether soldiers had a combat arms military occupational specialty (MOS) or other MOS (ORs = 1.4-2.3; P < .001).

The association remained significant regardless of unit size, with highest risk among participants in smaller units of one to 40 soldiers (ORs = 2.1-5.9; P < .001).

If risk could be reduced to no unit attempts, 18.2% of attempts would not occur, according to the population-attributable proportion for one or more past-year unit suicide attempts.

“The current Army STARRS findings represent an important contribution that highlights the need for further research on unit clustering, especially in light of the Army transformation of services after the study period,” Charles W. Hoge, MD, of Walter Reed Army Institute of Research, and colleagues wrote in an accompanying editorial. “Questions remain concerning the appropriate definition of unit-level clustering and contagion and how the epidemiology of attempt clusters correlates with suicide deaths. Research is needed to identify and validate clinical, organizational and communication strategies to reduce the potential for clustering within Army units.” – by Amanda Oldt

Disclosure: Ursano and Hoge report no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.