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Mental health issues underrecognized among soldiers who attempted suicide
More than one-third of enlisted soldiers with a documented suicide attempt did not have a prior mental health diagnosis, longitudinal study findings revealed.
“During the Iraq Afghanistan war, the rates of suicide and suicide attempt went up substantially for the U.S. Army,” Robert J. Ursano, MD, of the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences, told Healio Psychiatry.
“Among soldiers, as in the general population, mental disorders are consistent predictors of suicide attempt and death,” Ursano and colleagues wrote in the full study. “However, only 60% of enlisted soldiers with a documented suicide attempt and less than 50% of soldiers who died by suicide actually received a prior mental health diagnosis.”
In this retrospective longitudinal cohort study, the researchers used administrative data from the Army Study to Assess Risk and Resilience in Servicemembers to examine suicide-related risk factors among 9,650 soldiers who attempted suicide. They also examined whether risk factors varied by history of mental health issues in a stratified sample. Ursano and colleagues identified person-month records for all active-duty soldiers with a medically documented suicide attempt over a 5-year period (Jan. 1, 2004, to Dec. 31, 2009) and an equal-probability control sample of 153,528 people.
Among the soldiers with a documented suicide attempt, 3,507 (36.3%) did not have a prior mental health diagnosis. Almost 60% of undiagnosed soldiers who attempted suicide were in their first year of service compared with approximately 21% of those with previous mental health diagnosis.
Soldiers with history of mental health diagnosis history were more likely to have a suicide attempt (OR = 3.2; 95% CI, 3.1-3.3), which persisted after adjusting for sociodemographic and service-related factors (OR = 6.2; 95% CI, 5.9-6.5).
Odds of suicide attempt were higher among soldiers who were female, younger, white, less educated, in their first 4 years of service, never or previously deployed, and soldiers with a delayed promotion, demotion and combat arms or combat medic occupation. In addition, the odds of suicide attempt were also high among those with:
- eight or more outpatient care visits in the past 2 months;
- past-month injury-related outpatient and inpatient visits;
- prior combat injury;
- subjection to minor violent crime;
- major violent crime perpetration; and
- family violence.
Most variables were also tied to suicide attempts among soldiers with a previously diagnosed mental health condition, but the strength of associations differed, Ursano and colleagues reported.
“The value of mental health care working closely with primary care is a valuable model of care for aiding individuals who have not been identified yet as having mental health problems,” Ursano said. “Clinicians in primary care need to be alert that individuals who have not seen mental health care/or been given a mental health diagnosis are also at risk of suicide attempt. Screening for mental health problems in primary care is an important intervention- particularly for depression and suicide risk.”
These findings support the want for a public health approach to suicide prevention, as issued by U.S. National Strategy for Suicide Prevention, Mark A. Reger, PhD, from Veterans Affairs Puget Sound Health Care System in Seattle, and colleagues wrote in a related editorial.
“It is essential that suicide prevention efforts move outside of the silo of mental health. The results from Ursano et al support the recent changes by the Army to integrate mental health resources into a variety of nontraditional settings to increase access to care and decrease stigma,” Reger and colleagues wrote. “The findings, coupled with emerging literature, also point to life transitions as an opportunity to engage and support individuals who may be at risk for suicide behaviors.” – by Savannah Demko
Disclosure: Ursano reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. The editorial authors report no relevant financial disclosures.