Associations of Time-Related Deployment Variables With Risk of Suicide Attempt Among Soldiers: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

Importance There has been limited systematic examination of whether risk of suicide attempt (SA) among US Army soldiers is associated with time-related deployment variables, such as time in service before first deployment, duration of first deployment, and dwell time (DT) (ie, length of time between deployments). Objective To examine the associations of time-related deployment variables with subsequent SA among soldiers who had deployed twice. Design, Setting, and Participants Using administrative data from January 1, 2004, through December 31, 2009, this longitudinal, retrospective cohort study identified person-month records of active-duty Regular Army enlisted soldiers who had served continuously in the US Army for at least 2 years and deployed exactly twice. The dates of analysis were March 1 to December 1, 2017. There were 593 soldiers with a medically documented SA during or after their second deployment. An equal-probability sample of control person-months was selected from other soldiers with exactly 2 deployments (n = 19 034). Logistic regression analyses examined the associations of time in service before first deployment, duration of first deployment, and DT with subsequent SA. Main Outcomes and Measures Suicide attempts during or after second deployment were identified using US Department of Defense Suicide Event Report records and International Classification of Diseases, Ninth Revision, Clinical Modification E950 to E958 diagnostic codes. Independent variables were constructed from US Army personnel records. Results Among 593 SA cases, most were male (513 [86.5%]), white non-Hispanic (392 [66.1%]), at least high school educated (477 [80.4%]), currently married (398 [67.1%]), and younger than 21 years when they entered the US Army (384 [64.8%]). In multivariable models adjusting for sociodemographics, service-related characteristics, and previous mental health diagnosis, odds of SA during or after second deployment were higher among soldiers whose first deployment occurred within the first 12 months of service vs after 12 months (odds ratio, 2.0; 95% CI, 1.6-2.4) and among those with a DT of 6 months or less vs longer than 6 months (odds ratio, 1.6; 95% CI, 1.2-2.0). Duration of first deployment was not associated with subsequent SA. Analysis of 2-way interactions indicated that the associations of early deployment and DT with SA risk were not modified by other characteristics. Multivariable population-attributable risk proportions were 14.2% for deployment within the first 12 months of service and 4.0% for DT of 6 months or less. Conclusions and Relevance Time in service before first deployment and DT are modifiable risk factors for SA risk among soldiers.

[1]  R. Kessler,et al.  Suicide attempts in U.S. Army combat arms, special forces and combat medics , 2017, BMC Psychiatry.

[2]  Yu‐Chu Shen,et al.  Time-varying associations of suicide with deployments, mental health conditions, and stressful life events among current and former US military personnel: a retrospective multivariate analysis. , 2016, The lancet. Psychiatry.

[3]  R. Kessler,et al.  Risk Factors, Methods, and Timing of Suicide Attempts Among US Army Soldiers. , 2016, JAMA psychiatry.

[4]  Steven G Heeringa,et al.  Suicide Attempts in the US Army During the Wars in Afghanistan and Iraq, 2004 to 2009. , 2015, JAMA psychiatry.

[5]  Derek J Smolenski,et al.  Risk of Suicide Among US Military Service Members Following Operation Enduring Freedom or Operation Iraqi Freedom Deployment and Separation From the US Military. , 2015, JAMA psychiatry.

[6]  R. Kessler,et al.  Nonfatal Suicidal Behaviors in U.S. Army Administrative Records, 2004–2009: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) , 2015, Psychiatry.

[7]  M. Keeling,et al.  Mental health consequences of overstretch in the UK Armed Forces, 2007-09: a population-based cohort study. , 2014, The lancet. Psychiatry.

[8]  Murray B. Stein,et al.  The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) , 2014, Psychiatry.

[9]  R. Kessler,et al.  Predictors of suicide and accident death in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS): results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). , 2014, JAMA psychiatry.

[10]  M. Galarneau,et al.  Dwell time and psychological screening outcomes among military service members with multiple combat deployments. , 2014, Military medicine.

[11]  R. Kessler,et al.  Sociodemographic and career history predictors of suicide mortality in the United States Army 2004–2009 , 2014, Psychological Medicine.

[12]  Kimberley Watkins,et al.  Deployment Stressors : A Review of the Literature and Implications for Members of the Canadian Armed Forces , 2014 .

[13]  Nancy Gebler,et al.  Design of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) , 2013, International journal of methods in psychiatric research.

[14]  Besa Smith,et al.  Risk factors associated with suicide in current and former US military personnel. , 2013, JAMA.

[15]  S. Proctor,et al.  Relationships among predeployment risk factors, warzone-threat appraisal, and postdeployment PTSD symptoms. , 2013, Journal of traumatic stress.

[16]  T. Smith,et al.  Risk Factors AssociatedWith Suicide in Current and Former USMilitary Personnel , 2013 .

[17]  E. Teng,et al.  Perceived threat during deployment: Risk factors and relation to axis I disorders. , 2012 .

[18]  Amii M. Kress,et al.  Association between mental health conditions diagnosed during initial eligibility for military health care benefits and subsequent deployment, attrition, and death by suicide among active duty service members. , 2012, Military medicine.

[19]  I. Katz,et al.  Prevalence and characteristics of suicide ideation and attempts among active military and veteran participants in a national health survey. , 2012, American journal of public health.

[20]  D. Luxton,et al.  Addressing the surveillance goal in the National Strategy for Suicide Prevention: the Department of Defense Suicide Event Report. , 2012, American journal of public health.

[21]  Linda Cottrell,et al.  Suicide incidence and risk factors in an active duty US military population. , 2012, American journal of public health.

[22]  A. L. Dougherty,et al.  Effect of dwell time on the mental health of US military personnel with multiple combat tours. , 2012, American journal of public health.

[23]  Bruce H Jones,et al.  Mental health risk factors for suicides in the US Army, 2007–8 , 2012, Injury Prevention.

[24]  Mark Olfson,et al.  A systematic review of validated methods for identifying suicide or suicidal ideation using administrative or claims data , 2012, Pharmacoepidemiology and drug safety.

[25]  C. Witkop,et al.  Norovirus outbreak associated with person-to-person transmission, U.S. Air Force Academy, July 2011. , 2011, MSMR.

[26]  E. Ritchie,et al.  Prevalence and Risk Factors Associated With Suicides of Army Soldiers 2001–2009 , 2011 .

[27]  C. Hoge,et al.  Effectiveness of mental health screening and coordination of in-theater care prior to deployment to Iraq: a cohort study. , 2011, The American journal of psychiatry.

[28]  Christopher R. Erbes,et al.  Helping military families through the deployment process: Strategies to support parenting. , 2011, Professional psychology, research and practice.

[29]  Keith D. Renshaw,et al.  An integrated model of risk and protective factors for post-deployment PTSD symptoms in OEF/OIF era combat veterans. , 2011, Journal of affective disorders.

[30]  Associations between repeated deployments to Iraq (OIF/OND) and Afghanistan (OEF) and post-deployment illnesses and injuries, active component, U.S. Armed Forces, 2003-2010. Part II. Mental disorders, by gender, age group, military occupation, and "dwell times" prior to repeat (second through fifth) , 2011, MSMR.

[31]  Christopher Dandeker,et al.  The impact of deployment length on the health and well-being of military personnel: a systematic review of the literature , 2010, Occupational and Environmental Medicine.

[32]  Timothy M. Bonds,et al.  Army Deployments to Oif and Oef , 2010 .

[33]  M. Shea,et al.  Posttraumatic stress disorder symptoms and functional impairment among OEF and OIF National Guard and Reserve veterans. , 2010, Journal of traumatic stress.

[34]  Their Families,et al.  Returning Home from Iraq and Afghanistan: Preliminary Assessment of Readjustment Needs of Veterans, Service Members, and Their Families , 2010 .

[35]  D. Blazer,et al.  A prospective study of depression following combat deployment in support of the wars in Iraq and Afghanistan. , 2010, American journal of public health.

[36]  Robert D. Swanson,et al.  Association between number of deployments to Iraq and mental health screening outcomes in US Army soldiers. , 2009, The Journal of clinical psychiatry.

[37]  Bridget M. Kuehn,et al.  Soldier suicide rates continue to rise: military, scientists work to stem the tide. , 2009, JAMA.

[38]  Neil Greenberg,et al.  Mental health consequences of overstretch in the UK armed forces: first phase of a cohort study , 2007, BMJ : British Medical Journal.

[39]  Charles W Hoge,et al.  Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. , 2006, JAMA.

[40]  Paul D Bliese,et al.  The impact of deployment length and experience on the well-being of male and female soldiers. , 2005, Journal of occupational health psychology.

[41]  G. Wiser.  Together we stand, divided we fall. , 1996, Dental economics - oral hygiene.

[42]  J. Singer,et al.  Investigating onset, cessation, relapse, and recovery: why you should, and how you can, use discrete-time survival analysis to examine event occurrence. , 1993, Journal of consulting and clinical psychology.