Suicide risk factors for U.S. soldiers linked to pre- and post-enlistment mental health
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Pre-enlistment as well as immediate post-enlistment mental health status may help identify suicide risk in soldiers both with and without prior mental health diagnoses, according to a study published in JAMA Network Open.
“History of mental health diagnosis (MH-Dx) is among the most common risk factors for medically documented [suicide attempts] among soldiers,” James Naifeh, PhD, of the department of psychiatry at the Uniformed Services University of the Health Sciences in Maryland, and colleagues wrote. “However, more than one-third of soldiers who attempt suicide have not previously received an MH-Dx.”
Researchers sought to examine associations between premilitary mental health and medically documented suicide attempts among U.S. Army soldiers who did not receive a mental health diagnosis prior to their suicide attempt.
The cohort study utilized information from 21,722 soldiers (86.2% male, 61.8% white non-Hispanic) stationed at three Army installations who were entering basic training between April 2011 and November 2012, with a follow-up for the first 48 months of service. Each respondent’s survey responses were linked to their administrative records, which were analyzed for instances of pre-enlistment history of mental disorders, suicidal ideation, suicide attempts and nonsuicidal self-injury, as well as service-acquired MH-Dx and other service-related variables.
Logistic regression analysis examined associations of lifetime baseline survey variables with subsequent, medically documented suicide attempts among soldiers who did vs. those who did not receive an MH-Dx during service. Models were adjusted for time in service and sociodemographic and service-related variables.
Results showed 253 participants (75.4% male; 22.7% Black, 59.9% white non-Hispanic, 17.4% other race or ethnicity) made a suicide attempt within the first 48 months of service. For those who did and did not receive an MH-Dx during their service, risk of suicide attempt peaked toward the end of the first year. Of the 42.3% of individuals reporting at least one of the four baseline risk factors, 50.2% received an administrative MH-Dx during service compared with 41.5% of those with none, and 1.6% had a documented suicide attempt compared with 1.0% of those with none.
In addition, among participants with no MH-Dx, medically documented suicide attempts were associated with suicidal ideation (OR 2.2; 95% CI, 1.1-4.4), suicide attempt (OR, 11.3; 95% CI, 4.3-29.2) and nonsuicidal self-injury (OR, 3.0; 95% CI, 1.3-6.8). For those who received an MH-Dx, medically documented suicide attempts were associated with mental disorder (OR, 1.4; 95% CI, 1.0-1.9), SA (OR, 3.4; 95% CI, 2.1-5.6) and nonsuicidal self-injury (OR, 1.8; 95% CI, 1.1-2.8).
“A key component of detection of mental health problems, particularly among soldiers with no MH-Dx, is robust mental health care within primary care,” Naifeh and colleagues wrote.