May 1st, 2014

Reports: suicidal thoughts pre-date enlistment

Among other findings, new research suggests that soldiers experience the onset of suicidal thoughts and attempts before enlisting in the military and that many cases are linked with a prior mental disorder.

Three reports published online in the March 5 issue of JAMA Psychiatry discuss the results of the first set of data to come from a five-year study funded by the Department of the Army and the National Institutes of Health to look at suicide and the military. This study was done in response to a jump in the military suicide rate, which has been climbing since the beginning of the conflicts in Iraq and Afghanistan and in 2008, exceeded the demographically matched civilian rate, according to one of the reports.

In a study by Matthew Nock, Ph.D., professor of psychology at Harvard University, nearly 14 percent of soldiers reported that they seriously considered killing themselves at some point in their lives, about five percent made a suicide plan, and 2.5 percent actually attempted to kill themselves.

“What was surprising was that in most instances, suicidal thoughts and attempts had their onset before the soldiers joined the army and that most cases were linked with prior mental disorder,” he says. “One third of the disorders were present before enlistment. This (finding) suggests that there may be some signal present before people join the Army that the Army is not yet able to pick up on.”

This result also shows that servicemen and women are not disclosing this information before enlistment for fear of being screened out. Any individual information about a soldier was not going to be reported to the Army so soldiers felt more comfortable sharing with researchers, Nock says. “The trick, though, moving forward is how to get soldiers to report the presence of risk factors to other Army soldiers or clinicians.”

The report also found that five mental disorders predict post-enlistment first suicide attempts: pre-enlistment panic disorder, pre-enlistment posttraumatic stress disorder, post-enlistment depression and both pre- and post-enlistment intermittent explosive disorder. However, only post-enlistment intermittent explosive disorder predicts attempts among ideators, according to the report.

“What this suggests is that disorders like depression might get a soldier thinking about suicide and disorders like intermittent explosive disorder increase people’s risk of acting on their suicidal thoughts,” Nock says. “Clinically, I think this is very important information. It’s not just depression that clinicians should be attending to when measuring the risk of suicidal behavior – they must look more broadly.”

A report by lead author Ronald Kessler, Ph.D., found that 25 percent of soldiers meet criteria for a current mental disorder within the past 30 days, 76 percent of whom had a pre-enlistment onset, Nock says. Also, 12.8 percent of respondents reported severe role impairment, according to the study.

A third study by lead author Michael Schoenbaum, Ph.D., showed increased suicide risk being associated with being a man (or a woman during deployment), white race/ethnicity, junior enlisted rank, recent demotion and current or previous deployment, according to report. The study also showed that the “suicide rate has increased significantly among those who have not been deployed,” Nock says. “It’s something we have to try to figure out in future research. These papers scratch the surface.”

The papers by Nock and Kessler report on the first results of the Army STARRS (Army Study to Assess Risk and Resilience in Servicemembers), says Nock. “We had a representative sample of Army soldiers, so soldiers in all phases of their career were eligible for enrollment in the study. We had over 5,000 soldiers and asked them questions about their experience of suicidal behavior, various other disorders and other mental and psychological factors during their lifetime.”

The third paper used Army records to examine patterns of suicide and accidental death among army soldiers from 2004 to 2009 to test hypotheses about why the suicide rate increased so dramatically during that period, he says.

By Rivkela Brodsky

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