title: Risk for suicidal behaviors associated with PTSD, depression, and their comorbidity in the U.S. Army.
abstract: BACKGROUND
  Suicide rates have risen considerably in the United States Army in the past decade. Suicide risk is highest among those with past suicidality (suicidal ideation or attempts). The incidence of posttraumatic stress disorder (PTSD) and depressive illnesses has risen concurrently in the U.S. Army. We examined the relationship of PTSD and depression, independently and in combination, and rates of past-year suicidality in a representative sample of U.S. Army soldiers.
  
  
  METHODS
  This study used the DoD Survey of Health Related Behaviors Among Active Duty Military Personnel (DoD HRB) (N=5927). Probable PTSD and depression were assessed with the PTSD Checklist (PCL) and the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CES-D), respectively. Past-year suicidality was assessed via self-report.
  
  
  RESULTS
  Six percent of Army service members reported suicidality within the past year. PTSD and MDD were each independently associated with past-year suicidality. Soldiers with both disorders were almost three times more likely to report suicidality within the past year than those with either diagnosis alone. Population-attributable risk proportions for PTSD, depression, and both disorders together were 24%, 29%, and 45%, respectively.
  
  
  CONCLUSIONS
  The current study is subject to the limitations of a cross-sectional survey design and the self-report nature of the instruments used.
  
  
  CONCLUSIONS
  PTSD and depression are each associated with suicidality independently and in combination in the active duty component of the U.S. Army. Soldiers presenting with either but especially both disorders may require additional outreach and screening to decrease suicidal ideation and attempts.
authors.affiliation: Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, United States. Electronic address: holly.ramsawh.ctr@usuhs.edu.
authors.forename: Holly J
authors.initials: HJ
authors.lastname: Ramsawh
authors.affiliation: Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
authors.forename: Carol S
authors.initials: CS
authors.lastname: Fullerton
authors.affiliation: Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
authors.forename: Holly B Herberman
authors.initials: HB
authors.lastname: Mash
authors.affiliation: Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
authors.forename: Tsz Hin H
authors.initials: TH
authors.lastname: Ng
authors.affiliation: Harvard Medical School, Department of Health Care Policy, Boston, MA, United States.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
authors.affiliation: University of California, San Diego, Departments of Psychiatry & Family and Preventive Medicine, San Diego, CA, United States; Psychiatry Service, Veterans Affairs, San Diego Healthcare System, San Diego, CA, United States.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
authors.affiliation: Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Ursano
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology*; D012306:Risk; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology*; D059020:Suicidal Ideation; D013405:Suicide / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult
keywords: Attempted; Depression; Military personnel; Post-traumatic; Stress disorders; Suicidal ideation