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Abstract

Objective:

The authors sought to identify predictors of imminent suicide attempt (within 30 days) among U.S. Army soldiers following their first documented suicidal ideation.

Methods:

Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers, the authors identified 11,178 active-duty Regular Army enlisted soldiers (2006–2009) with medically documented suicidal ideation and no prior medically documented suicide attempts. The authors examined risk factors for suicide attempt within 30 days of first suicidal ideation using logistic regression analyses, including sociodemographic and service-related characteristics, psychiatric diagnoses, physical health care visits, injuries, and history of family violence or crime perpetration or victimization.

Results:

Among soldiers with first documented suicidal ideation, 830 (7.4%) attempted suicide, 46.3% of whom (N=387) attempted suicide within 30 days (rate, 35.4 per 1,000 soldiers). Following a series of multivariate analyses, the final model identified females (odds ratio=1.3, 95% CI=1.0, 1.8), combat medics (odds ratio=1.6, 95% CI=1.1, 2.2), individuals with an anxiety disorder diagnosis prior to suicidal ideation (odds ratio=1.3, 95% CI=1.0, 1.6), and those who received a sleep disorder diagnosis on the same day as the recorded suicidal ideation (odds ratio=2.3, 95% CI=1.1, 4.6) as being more likely to attempt suicide within 30 days. Black soldiers (odds ratio=0.6, 95% CI=0.4, 0.9) and those who received an anxiety disorder diagnosis on the same day as suicidal ideation (odds ratio=0.7, 95% CI=0.5, 0.9) were less likely.

Conclusions:

Suicide attempt risk is highest in the first 30 days following ideation diagnosis and is more likely among women, combat medics, and soldiers with an anxiety disorder diagnosis before suicidal ideation and a same-day sleep disorder diagnosis. Black soldiers and those with a same-day anxiety disorder diagnosis were at decreased risk. These factors may help identify soldiers at imminent risk of suicide attempt.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 1050 - 1059
PubMed: 34465200

History

Received: 4 November 2020
Revision received: 23 February 2021
Revision received: 27 April 2021
Accepted: 17 May 2021
Published online: 1 September 2021
Published in print: November 2021

Keywords

  1. Suicide Attempt
  2. Suicidal Ideation
  3. Suicidal Behavior
  4. Military

Authors

Details

Holly B. Herberman Mash, Ph.D.
Center for the Study of Traumatic Stress, Department of Psychiatry (Mash, Ursano, Naifeh, Fullerton, Aliaga, Riggs-Donovan, Dinh, Vance, Wynn), and Department of Preventive Medicine and Biostatistics (Kao), Uniformed Services University of the Health Sciences, Bethesda, Md.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md. (Mash, Naifeh, Aliaga, Riggs-Donovan, Dinh, Vance); Department of Health Care Policy, Harvard Medical School, Boston (Kessler, Zaslavsky, Sampson); Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, and VA San Diego Healthcare System, San Diego (Stein).
Robert J. Ursano, M.D. [email protected]
Center for the Study of Traumatic Stress, Department of Psychiatry (Mash, Ursano, Naifeh, Fullerton, Aliaga, Riggs-Donovan, Dinh, Vance, Wynn), and Department of Preventive Medicine and Biostatistics (Kao), Uniformed Services University of the Health Sciences, Bethesda, Md.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md. (Mash, Naifeh, Aliaga, Riggs-Donovan, Dinh, Vance); Department of Health Care Policy, Harvard Medical School, Boston (Kessler, Zaslavsky, Sampson); Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, and VA San Diego Healthcare System, San Diego (Stein).
Ronald C. Kessler, Ph.D.
Center for the Study of Traumatic Stress, Department of Psychiatry (Mash, Ursano, Naifeh, Fullerton, Aliaga, Riggs-Donovan, Dinh, Vance, Wynn), and Department of Preventive Medicine and Biostatistics (Kao), Uniformed Services University of the Health Sciences, Bethesda, Md.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md. (Mash, Naifeh, Aliaga, Riggs-Donovan, Dinh, Vance); Department of Health Care Policy, Harvard Medical School, Boston (Kessler, Zaslavsky, Sampson); Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, and VA San Diego Healthcare System, San Diego (Stein).
James A. Naifeh, Ph.D.
Center for the Study of Traumatic Stress, Department of Psychiatry (Mash, Ursano, Naifeh, Fullerton, Aliaga, Riggs-Donovan, Dinh, Vance, Wynn), and Department of Preventive Medicine and Biostatistics (Kao), Uniformed Services University of the Health Sciences, Bethesda, Md.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md. (Mash, Naifeh, Aliaga, Riggs-Donovan, Dinh, Vance); Department of Health Care Policy, Harvard Medical School, Boston (Kessler, Zaslavsky, Sampson); Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, and VA San Diego Healthcare System, San Diego (Stein).
Carol S. Fullerton, Ph.D.
Center for the Study of Traumatic Stress, Department of Psychiatry (Mash, Ursano, Naifeh, Fullerton, Aliaga, Riggs-Donovan, Dinh, Vance, Wynn), and Department of Preventive Medicine and Biostatistics (Kao), Uniformed Services University of the Health Sciences, Bethesda, Md.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md. (Mash, Naifeh, Aliaga, Riggs-Donovan, Dinh, Vance); Department of Health Care Policy, Harvard Medical School, Boston (Kessler, Zaslavsky, Sampson); Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, and VA San Diego Healthcare System, San Diego (Stein).
Pablo A. Aliaga, M.S.
Center for the Study of Traumatic Stress, Department of Psychiatry (Mash, Ursano, Naifeh, Fullerton, Aliaga, Riggs-Donovan, Dinh, Vance, Wynn), and Department of Preventive Medicine and Biostatistics (Kao), Uniformed Services University of the Health Sciences, Bethesda, Md.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md. (Mash, Naifeh, Aliaga, Riggs-Donovan, Dinh, Vance); Department of Health Care Policy, Harvard Medical School, Boston (Kessler, Zaslavsky, Sampson); Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, and VA San Diego Healthcare System, San Diego (Stein).
Charlotte A. Riggs-Donovan, M.S.
Center for the Study of Traumatic Stress, Department of Psychiatry (Mash, Ursano, Naifeh, Fullerton, Aliaga, Riggs-Donovan, Dinh, Vance, Wynn), and Department of Preventive Medicine and Biostatistics (Kao), Uniformed Services University of the Health Sciences, Bethesda, Md.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md. (Mash, Naifeh, Aliaga, Riggs-Donovan, Dinh, Vance); Department of Health Care Policy, Harvard Medical School, Boston (Kessler, Zaslavsky, Sampson); Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, and VA San Diego Healthcare System, San Diego (Stein).
Hieu M. Dinh, B.S.
Center for the Study of Traumatic Stress, Department of Psychiatry (Mash, Ursano, Naifeh, Fullerton, Aliaga, Riggs-Donovan, Dinh, Vance, Wynn), and Department of Preventive Medicine and Biostatistics (Kao), Uniformed Services University of the Health Sciences, Bethesda, Md.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md. (Mash, Naifeh, Aliaga, Riggs-Donovan, Dinh, Vance); Department of Health Care Policy, Harvard Medical School, Boston (Kessler, Zaslavsky, Sampson); Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, and VA San Diego Healthcare System, San Diego (Stein).
Mary C. Vance, M.D., M.Sc.
Center for the Study of Traumatic Stress, Department of Psychiatry (Mash, Ursano, Naifeh, Fullerton, Aliaga, Riggs-Donovan, Dinh, Vance, Wynn), and Department of Preventive Medicine and Biostatistics (Kao), Uniformed Services University of the Health Sciences, Bethesda, Md.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md. (Mash, Naifeh, Aliaga, Riggs-Donovan, Dinh, Vance); Department of Health Care Policy, Harvard Medical School, Boston (Kessler, Zaslavsky, Sampson); Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, and VA San Diego Healthcare System, San Diego (Stein).
Gary H. Wynn, M.D.
Center for the Study of Traumatic Stress, Department of Psychiatry (Mash, Ursano, Naifeh, Fullerton, Aliaga, Riggs-Donovan, Dinh, Vance, Wynn), and Department of Preventive Medicine and Biostatistics (Kao), Uniformed Services University of the Health Sciences, Bethesda, Md.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md. (Mash, Naifeh, Aliaga, Riggs-Donovan, Dinh, Vance); Department of Health Care Policy, Harvard Medical School, Boston (Kessler, Zaslavsky, Sampson); Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, and VA San Diego Healthcare System, San Diego (Stein).
Alan M. Zaslavsky, Ph.D.
Center for the Study of Traumatic Stress, Department of Psychiatry (Mash, Ursano, Naifeh, Fullerton, Aliaga, Riggs-Donovan, Dinh, Vance, Wynn), and Department of Preventive Medicine and Biostatistics (Kao), Uniformed Services University of the Health Sciences, Bethesda, Md.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md. (Mash, Naifeh, Aliaga, Riggs-Donovan, Dinh, Vance); Department of Health Care Policy, Harvard Medical School, Boston (Kessler, Zaslavsky, Sampson); Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, and VA San Diego Healthcare System, San Diego (Stein).
Nancy A. Sampson, B.A.
Center for the Study of Traumatic Stress, Department of Psychiatry (Mash, Ursano, Naifeh, Fullerton, Aliaga, Riggs-Donovan, Dinh, Vance, Wynn), and Department of Preventive Medicine and Biostatistics (Kao), Uniformed Services University of the Health Sciences, Bethesda, Md.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md. (Mash, Naifeh, Aliaga, Riggs-Donovan, Dinh, Vance); Department of Health Care Policy, Harvard Medical School, Boston (Kessler, Zaslavsky, Sampson); Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, and VA San Diego Healthcare System, San Diego (Stein).
Tzu-Cheg Kao, Ph.D.
Center for the Study of Traumatic Stress, Department of Psychiatry (Mash, Ursano, Naifeh, Fullerton, Aliaga, Riggs-Donovan, Dinh, Vance, Wynn), and Department of Preventive Medicine and Biostatistics (Kao), Uniformed Services University of the Health Sciences, Bethesda, Md.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md. (Mash, Naifeh, Aliaga, Riggs-Donovan, Dinh, Vance); Department of Health Care Policy, Harvard Medical School, Boston (Kessler, Zaslavsky, Sampson); Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, and VA San Diego Healthcare System, San Diego (Stein).
Murray B. Stein, M.D., M.P.H.
Center for the Study of Traumatic Stress, Department of Psychiatry (Mash, Ursano, Naifeh, Fullerton, Aliaga, Riggs-Donovan, Dinh, Vance, Wynn), and Department of Preventive Medicine and Biostatistics (Kao), Uniformed Services University of the Health Sciences, Bethesda, Md.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md. (Mash, Naifeh, Aliaga, Riggs-Donovan, Dinh, Vance); Department of Health Care Policy, Harvard Medical School, Boston (Kessler, Zaslavsky, Sampson); Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, and VA San Diego Healthcare System, San Diego (Stein).

Notes

Send correspondence to Dr. Ursano ([email protected]).

Competing Interests

Dr. Kessler has received support for epidemiological studies from Sanofi-Aventis; he has served as a consultant for DataStat, Holmusk, Johnson & Johnson Wellness and Prevention, RallyPoint Networks, Sage Pharmaceuticals, Shire, and Takeda and on advisory boards for Johnson & Johnson Services Lake Nona Life Project; and he has stock options in Mirah, PYM, and Roga Sciences. Dr. Stein has received research support from the Department of Defense, the Department of Veterans Affairs, and NIH; he has served as a consultant for Actelion, Acadia Pharmaceuticals, Aptinyx, ATAI Life Sciences, Boehringer Ingelheim, Bionomics, BioXcel Therapeutics, Clexio, EmpowerPharm, Engrail Therapeutics, GW Pharmaceuticals, Janssen, Jazz Pharmaceuticals, and Roche/Genentech and on scientific advisory boards for the Anxiety and Depression Association of America and the Brain and Behavior Research Foundation; he receives remuneration for his editorial work on Depression and Anxiety (Editor-in-Chief), Biological Psychiatry (Deputy Editor), and UpToDate (Co-Editor-in-Chief for Psychiatry); and he has stock options in Epivario and Oxeia Biopharmaceuticals. The other authors report no financial relationships with commercial interests.

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