Army Recruits’ Mental Disorder Rates Similar to Those of Civilians’

Recruits entering the U.S. Army appear to bring with them many of the same psychological issues as their civilian counterparts, but that may represent an opportunity for intervention rather than a disadvantage, according to several reports from an ongoing investigation of suicidality in the Army.

The New Soldier Study, a part of the larger Army STARRS study, drew from samples of soldiers going through basic combat training in 2011 and 2012. It found a 38.7 percent lifetime prevalence of any DSM-IV psychiatric disorder, not significantly different from the 36.5 percent rate among civilians reported in the National Comorbidity Survey Replication.

Overall, soldiers and civilians had similar rates of specific disorders, but rates of generalized anxiety disorder and posttraumatic stress disorder (PTSD) were several times higher among the military sample, possibly reflecting more preenlistment trauma exposure, wrote Anthony Rosellini, Ph.D., a research fellow in the Department of Health Care Policy at Harvard Medical School, and colleagues in the journal Depression and Anxiety, published on October 22.

There were small but statistically significant associations with some demographic factors, notably “higher rates of internalizing disorders among women and soldiers with non-Western religions; higher rates of externalizing disorders among men and the unmarried; and inverse associations of age, minority status (non-Hispanic black and Hispanic), soldier and parent education, and immigrant status with both internalizing and externalizing disorders,” said the authors.

Mental disorders existing prior to military service may become more salient or chronic given the stresses of Army life and training, they said. Identifying recruits with these disorders could present an opportunity for interventions. Trying to screen them out of the Army in advance would be less likely to succeed, however, given that their rates of mental disorders are indistinguishable from comparable civilian populations, suggested the authors.

A second study looked at data on suicidality from the same cohort of new soldiers. Lifetime prevalence (mostly before enlistment) of suicide ideation was 14.1 percent, of suicide plans 2.3 percent, and of attempts 1.9 percent.

“[N]ew soldiers have higher rates of suicide ideation than their matched civilian peers, but lower rates of progressing to suicidal plans and attempts,” wrote Robert Ursano, M.D., a professor and chair of psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Md., and colleagues, also in Depression and Anxiety.

Gaining truthful responses about such a heavily stigmatized matter as suicidality is always a challenging proposition, given soldiers’ concerns about their career prospects, said Ursano in an interview with Psychiatric News. “But these surveys were carried out under scrupulous standards of confidentiality.”

There were “weak” correlations between suicidality and being female, unmarried, adhering to a religion other than Protestant or Catholic, and “a race/ethnicity other than non-Hispanic white, non-Hispanic black, or Hispanic.”

Recruits who had not earned a high school diploma had lower odds of having suicidal ideation and plans, but were more likely to attempt suicide, researchers found. “It may be that some third variable, such as impulsiveness, is associated with failure to obtain a high school diploma and also increases the likelihood of acting on suicidal thoughts.”

The intersection of Army regulations and suicidality is complicated. Suicidal behavior is a bar to enlistment, but does not disqualify a soldier from remaining in the service. Since prior suicidality is a leading predictor of later suicidal behavior, said the authors, “identifying new soldiers with prior suicidal behavior could represent an important means of targeting preventive interventions” while retaining these recruits.

The Army STARRS project has recently been awarded funding to begin a longitudinal study in 2015 to follow this cohort through their military careers and afterward.

An abstract of “Lifetime Prevalence of DSM-IV Mental Disorders Among New Soldiers in the U.S. Army: Results From the Army Study to Assess Risk and Resilience in Service Members (Army STARRS)” can be accessed here. “Prevalence and Correlates of Suicidal Behavior Among New Soldiers in the U.S. Army: Results From the Army Study to Assess Risk and Resilience in Service Members (Army STARRS)” is available here. “Predicting Suicides After Psychiatric Hospitalization in U.S. Army Soldiers: The Army Study to Assess Risk and Resilience in Service Members (Army STARRS)” is posted here.