STARRS Findings Shed More Light On Army Suicides

The latest published findings from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) has found that the odds of a suicide attempt among U.S. Army soldiers were greater for those who deployed within their first year in the service and for those with less than six months between their first and second deployments.

The results may have implications for Army training and length of time between deployments, wrote Robert Ursano, M.D., and colleagues in JAMA Psychiatry on April 18. Ursano is 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 (USUHS) in Bethesda, Md.

Army STARRS researchers collected data on 1.6 million active-duty soldiers from 2004 to 2009 in a project designed to investigate risk factors and protective factors for suicide, suicidal behavior, and other mental or behavioral health issues.

“There were nearly 10,000 suicide attempts overall during that time,” said Ursano in an interview. “Suicide attempts are indicators of individuals in need of care. For the Army, they also carry a cost in how they affect units.”

Ursano and co-author Murray Stein, M.D., M.P.H., a professor of psychiatry and family medicine and public health at the University of California, were co-principal investigators on Army STARRS. The project not only gathered new data as the United States was fighting two wars; it also pulled together material previously recorded but not held in one place.

“At first, Army STARRS told us much of what we already knew, but now we are able to quantify that information,” commented retired Army psychiatrist Elspeth Cameron Ritchie, M.D., M.P.H., a professor of psychiatry at USUHS and a clinical professor at Georgetown University and George Washington University, in an interview. Ritchie was not involved with the current study. “The important thing about this study is that it not only gathered data but also made some practical suggestions about what may be done to reduce the risk of suicide attempts.”

For the current study, the researchers collected administrative data records on a sample of 593 soldiers who had served between 2004 and 2009, had completed exactly two deployments, and had documented suicide attempts during or after their second deployment. They were matched with a control sample amounting to 19,023 person-months. Most of the soldiers were male (86.5 percent), currently married (67.1 percent), and had joined the Army before age 21 (64.8 percent).

No effects were found relating to military occupational specialty, sex, deployment status, duration of first deployment, or previous mental health diagnosis, said the authors. The risks of combat experience itself or of high-risk military specialties, like combat medics, could not be determined in this study. Time-related variables were adjusted for sociodemographic and service-related factors.

Soldiers who had served 12 months or less before their first deployment had greater odds of a suicide attempt (odds ratio, 1.7) during or after their second deployment. That risk might be reduced if soldiers “had more time to train and acclimate to the military before their initial deployment,” suggested the researchers.

A second variable was “dwell time,” the period between deployments when soldiers recover from their experiences in the war zone and train for future duty. After adjustment, a dwell time of six months or less also was associated with increased risk of a suicide attempt (odds ratio, 1.8). Prior research has found that dwell times for troops of 30 to 36 months are associated with reduced rates of acute stress, anxiety, and depression compared with troops who had not been deployed.

Dwell time is not as simple to control as it may seem, said Ritchie. “Military leaders appreciate the need for a longer time between deployments, but if you have a war to fight, you have to balance your options.”

The study indicates that suicide attempts might be reduced by 14.2 percent if the initial training period is greater than 12 months and by 4.0 percent if the dwell time is at least six months, said the authors.

“We were surprised by the clarity of the findings and the strength of the association of risk with early deployment,” added Ursano. “The lack of findings related to length of deployment highlight the dynamic nature of deployment and the many ‘moving parts’ that must be considered.” ■