Army, NIMH Search for Causes of Soldier Suicide Crisis

The National Institute of Mental Health (NIMH) has tapped a consortium of four research universities to investigate risk and protective factors influencing a troubling increase in suicides in the U.S. Army.

The number of suicides by U.S. soldiers has risen steadily in recent years until levels have equaled those among comparable civilians, who historically have had higher rates. Responding to concern from Congress, the public, and Pentagon officials, the Army allotted $50 million to NIMH for the new study, whose goal is to “provide a science base for effective and practical interventions to reduce suicide rates and address associated mental health problems,” according to an NIMH statement.

Such large, longitudinal studies that look at risk and protective factors are unusual in military populations, said Robert Heinssen, Ph.D., acting director of the Division of Services and Intervention Research at NIMH. But the study is unlikely to come up with a single cause for military suicides, he told Psychiatric News.

“[The researchers] are really searching for likely, but weakly linked, risk factors that in combination might create different risk states over time,” he said.

The new study will draw on soldiers' personnel and health records and will survey several hundred thousand current soldiers and incoming recruits over the next five years.

The Army now investigates every suicide within the service. It began issuing public reports in 2007 and stated that failed marital or other relationships were most strongly associated with suicide (Psychiatric News, September 21, 2007).

Robert Ursano, M.D., director of the Center for Traumatic Stress Studies at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Md., where he also chairs the Department of Psychiatry, will direct the project, the largest ever military study of suicide and mental health.

“This is a unique joining of the Department of Defense and the NIMH to address an issue of national security that will also build tools with peacetime implications,” Ursano told Psychiatric News.

His principal collaborators will each add a different area of expertise to USUHS's familiarity with military epidemiology. Stephen Heeringa, Ph.D., of the University of Michigan's Institute for Social Research has experience in securely handling large datasets. Ronald Kessler, Ph.D., of Harvard Medical School is a leading psychiatric epidemiologist, while Columbia University's J. John Mann, M.D., has extensively studied the neurobiology of suicide and the use of the psychological autopsy to examine factors leading up to the event.

The study is a collaborative research project grant, NIMH's term for projects in which the government takes a direct interest beyond routine management, said Heinssen in an interview.

“Two NIMH scientific officers—a psychiatric epidemiologist and a mental health services researcher—will participate as investigators, working on ways to integrate data from surveys with the data the Army routinely collects,” said Heinssen.

Several researchers with military backgrounds are also involved in the project, including psychiatric epidemiologist Col. Charles Hoge, director of the Division of Psychiatry and Behavioral Sciences at Walter Reed Army Institute of Research in Silver Spring, Md., and Col. Charles Engel, assistant chair of the Department of Psychiatry at USUHS.

Former APA President Paul Appelbaum, M.D., the Elizabeth K. Dollard Professor of Psychiatry, Medicine, and Law and director of the Division of Psychiatry, Law, and Ethics at the Department of Psychiatry at Columbia University College of Physicians and Surgeons, will chair the project's ethics committee, which faces two primary challenges in a study of military populations: confidentiality of information and voluntariness of consent to protect soldiers from coercion and undue influence.