Suicide Attempts Linked to Previous Attempts in Soldiers’ Unit, Says Army Study
Rates of suicide attempts in the U.S. Army from 2004 to 2009 were associated as much with the environment as a soldier’s own circumstances.
The latest report from a long-term study of suicidality in the U.S. Army indicates that a prior-year history of suicide attempts in an Army unit was associated with an increased risk of such attempts by other soldiers in that unit.
The findings, published online on July 26 in JAMA Psychiatry, indicate that units with a history of suicide attempts may be important targets for preventive interventions.
“Early unit-based postvention consisting of coordinated efforts to provide behavioral, psychosocial, spiritual, and public health support after suicide attempts may be an essential tool in promoting recovery and suicide prevention in servicemembers,” wrote the researchers.
Researchers for the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) used Army administrative data from 2004 through 2009 to compare records of 9,512 enlisted personnel who attempted suicide with 151,526 control person-months.
Robert Ursano, M.D., notes that one factor that might influence the occurrence of multiple suicides in a unit is stress from deployment or change in command.
“We saw substantially higher odds ratios across unit sizes and across different military occupational specialties,” said lead author Robert Ursano, M.D., a professor of psychiatry and neuroscience and director of the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences in Bethesda, Md.
The study found that soldiers were more likely to attempt suicide if at least one other soldier in the unit had attempted suicide. The risk rose as attempts increased within a unit. Soldiers in units that experienced five or more attempts in the prior year were 2.3 times more likely to attempt suicide than those in units with no attempts, said the authors.
Suicide attempts were significantly associated with a prior mental health diagnosis, but not with suicide deaths, combat, unintentional injury, or Army occupation category. Suicide attempts occurring in smaller units (one to 40 soldiers) were also linked with increased risk.
“Unit characteristics that persist over time, including leadership quality, extent of social support and cohesion, and presence of bullying, may influence unit culture and affect the likelihood of and responses to unit [suicide attempts],” said the authors.
“This paper is extremely elegant and adds methodologically to the field in its consideration of the environment and unit size,” said retired Brig. Gen. Stephen Xenakis, a former Army psychiatrist, in an interview. “Command climate is so important in small units composed of young people, so the critical person is the squad leader, who leads perhaps a dozen soldiers.”
Xenakis, who was not involved with the study, raised the as-yet-unsettled issue of contagion—the idea that a suicide attempt in one’s unit gives “permission” to consider a situation so intractable that ending one’s life is the only answer. However, Ursano cautioned that other factors may play a significant role as well.
“Just because we can identify clusters of suicide attempts within a unit, we should not necessarily conclude that the mechanism connecting them is ‘contagion,’ ” said Ursano in an interview. “It could be a unit under high stress, whether from operations, deployment, or a change of command.”
The study focused on the period 2004 to 2009, before the Army took steps to address the high rates of suicide, said Xenakis. Beginning in 2010, the service assigned behavioral health specialists to combat units where they could get to know soldiers and talk with them on a routine basis. They could then identify individuals with serious mental health problems and refer them to more experienced clinical help when needed.
Another study, called Army STARRS Longitudintal Study (STARRS-LS), will gather data from 2010 to 2015 and is in the early stages of developing suicide prevention strategies integrating behavioral, psychosocial, spiritual, and public health support.
“The findings themselves are a reminder of the importance of community to mental health,” said Ursano. “It’s good to be reminded that communities, families, and neighbors form a substantial part of both protecting one’s mental health as well as potentially increasing the risk to one’s mental health.” ■
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Published online: 14 September 2017
Published in print: September 2, 2017 – September 15, 2017
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