3 Studies, Editorial Examine Mental Health Issues in Army

FOR IMMEDIATE RELEASE

Media Advisory: To contact Michael Schoenbaum, Ph.D., call Jim McElroy at 301-443-4536 or email NIMHPress@nih.gov. To contact author Ronald C. Kessler, Ph.D., call, call David Cameron at 617.432.0442 or email david_cameron@hms.harvard.edu . To contact Matthew K. Nock, Ph.D., or call Peter Reuell at 617-495-1585 or email preuell@harvard.edu. To contact editorial author Matthew J. Friedman, M.D., Ph.D., call Derik Hertel at 603-650-1203 or email Kenneth.D.Hertel@dartmouth.edu.

JAMA Psychiatry Study Highlights

 

Editor’s Note: JAMA Psychiatry is publishing three studies and an editorial examining mental health issues in the Army from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) collaborators. 

 

Predictors of Suicide, Accident Death Among Army Soldiers

Bottom Line: Being white, a man, having a junior enlisted rank, recently being demoted, and having a current or previous deployment was associated with increased risk for suicide among Army soldiers.

 

Authors: Michael Schoenbaum, Ph.D., National Institute of Mental Health, Bethesda, Md., and colleagues.

 

Background: The suicide rate in the U.S. military has climbed steadily since the beginning of the Iraq and Afghanistan conflicts, and in 2008 it exceeded the civilian rate. The Army responded by partnering with the National Institute of Mental Health to jointly fund the Army STARRS survey to better understand risk factors for suicide among soldiers.

 

How the Study Was Conducted: The authors analyzed trends in risk factors for suicide and accident deaths using Army and Department of Defense data systems. They focused on all 975,057 regular Army soldiers on active duty between 2004 and 2009. There were 569 deaths classified as suicides by the Armed Forces Medical Examiner and another 1,331 deaths classified as accidents.

 

Results: Suicides increased between 2004 and 2009 among never deployed and currently and previously deployed Army soldiers. The accident rate declined among currently deployed soldiers (possibly reflecting changes in the nature of Army operations) but remained constant among previously deployed soldiers and trended upward among soldiers never deployed. Demographic and Army experience factors were similar for suicides and accident deaths. For example, women have a consistently lower suicide risk than men and the youngest soldiers have an increased risk of suicide during and after deployment. Married soldiers and those with children have a lower suicide risk than unmarried soldiers without dependents during deployment but not among either the never deployed or previously deployed. Authors found no consistent associations between suicide risk and accession waivers, which is the acceptance of applicants who do not fully meet Army admission standards, or stop loss orders, which require soldiers to serve past their original obligation.

 

Discussion:  “These results set the stage for more in-depth analyses aimed at helping the Army target both high-risk soldiers and high-risk situations, as well as at developing, implementing and evaluating preventive interventions to reverse the rising Army suicide rate.”

(JAMA Psychiatry. Published online March 3, 2014. doi:10.1001/jamapsychiatry.2013.4417. Available pre-embargo to the media at http://media.jamanetwork.com.)

 

Editor’s Note: Authors made conflict of interest disclosures. Army STARRS was sponsored by the Department of the Army and funded under a cooperative agreement with the U.S. Department of Health and Human Services, the National Institutes of Health, National Institute of Mental Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

 

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Mental Disorders Among Nondeployed Soldiers

 

Bottom Line: A quarter of active duty, non-deployed Army soldiers who participated in a mental health assessment met criteria for at least one psychiatric disorder and 11 percent met criteria for multiple disorders.

 

Authors: Ronald C. Kessler, Ph.D., of the Harvard Medical School, Boston, and colleagues.

 

Background: Mental health disorders are a leading cause of illness in the U.S. military. Health care visits and days out of work due to mental health issues are second only to those due to injuries among service members.

 

How the Study Was Conducted: The authors used data from a representative sample of 5,428 soldiers who participated in the Army STARRS survey.

 

Results:  Of the service members who met criteria for psychiatric disorders, 76.6 percent had pre-enlistment onsets — 49.6 percent were internalizing disorders (major depressive, bipolar, generalized anxiety, panic and posttraumatic stress disorders) and 81.7 percent were externalizing disorders (attention-deficit/ hyperactivity disorder [ADHD] , intermittent explosive [anger] disorder and alcohol/drug problems). Nearly 13 percent of soldiers reported severe impairment of their ability to carry out their Army roles.

 

Discussion: “Implications of these findings for recruitment are unclear because the Army already screens for emotional problems in pre-enlistment health examinations. However, knowledge that new recruits have high externalizing disorder rates (even if denied in recruitment interviews) might be useful to the Army in developing targeted outreach intervention programs for new soldiers such as interventions for ADHD and for problems with anger management.”

(JAMA Psychiatry. Published online March 3, 2014. doi:10.1001/jamapsychiatry.2014.28. Available pre-embargo to the media at http://media.jamanetwork.com.)

 

Editor’s Note: Authors made conflict of interest disclosures. Army STARRS was sponsored by the Department of the Army and funded under a cooperative agreement with the U.S. Department of Health and Human Services, the National Institutes of Health, National Institute of Mental Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Suicidal Behavior Among Soldiers

 

Bottom Line: Researchers report about one-third of post-enlistment suicide attempts by Army soldiers are associated with pre-enlistment mental disorders, and post-enlistment suicide attempts are associated with being a woman, having a lower rank and being previously deployed.

 

Authors: Matthew K. Nock, Ph.D., of Harvard University, Cambridge, Mass., and colleagues.

 

Background: Army suicides have increased in recent years for unknown reasons.

 

How the Study Was Conducted: The authors used survey data from 5,428 nondepolyed soldiers who responded to the Army STARRS survey to examine the association of lifetime mental disorders and pre- and post-enlistment onsets with subsequent suicidal thoughts, plans and attempts.

 

Results: Among the soldiers, the lifetime prevalence of suicidal thoughts, plans and attempts were 13.9 percent, 5.3 percent and 2.4 percent, respectively, and most reported cases had onsets that were pre-enlistment. Five mental disorders were associated with a first suicide attempt post-enlistment: pre-enlistment panic disorder, pre-enlistment posttraumatic stress disorder, post-enlistment depression and both pre- and post-enlistment intermittent explosive (anger) disorder.

 

Discussion: “The possibility of higher fatality rates among Army suicide attempts than among civilian suicide attempts highlights the potential importance of means control (i.e., restricting access to lethal means [such as firearms]) as a suicide prevention strategy.”

(JAMA Psychiatry. Published online March 3, 2014. doi:10.1001/jamapsychiatry.2014.30. Available pre-embargo to the media at http://media.jamanetwork.com.)

 

Editor’s Note: Authors made conflict of interest disclosures. Army STARRS was sponsored by the Department of the Army and funded under a cooperative agreement with the U.S. Department of Health and Human Services, the National Institutes of Health, National Institute of Mental Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Editorial: Suicide Risk Among Soldiers

In a related editorial, Matthew J. Friedman, M.D., Ph.D., of the Geisel School of Medicine at Dartmouth, Hanover, N.H., writes: “Rather than discuss each study separately, I will synthesize the information from all three studies. To me, the most striking findings concern suicides among nondeployed soldiers and the effect of a pre-enlistment psychiatric disorder on suicidal behavior, psychiatric morbidity, and functional impairment. These findings have major implications for screening, assessment, recruitment, and retention of volunteers seeking military enlistment.”

 

“These are the only the first articles to come from the groundbreaking Army STARRS initiative. Future articles will hopefully provide finer-grained measurements and more in-depth analyses of the variables already mentioned, as well as new information on psychological, neurocognitive, social, biological and genetic factors. They will also investigate the impact of intervention,” Friedman continues.

 

“The current articles have already provided a very rich context and raise some important issues that were less apparent previously. Even without further data, we know enough to begin to consider better assessment, monitoring and intervention strategies,” he concludes.

(JAMA Psychiatry. Published online March 3, 2014. doi:10.1001/jamapsychiatry.2014.24. Available pre-embargo to the media at http://media.jamanetwork.com.)

 

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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