title: Understanding the elevated suicide risk of female soldiers during deployments.
abstract: BACKGROUND
  The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) has found that the proportional elevation in the US Army enlisted soldier suicide rate during deployment (compared with the never-deployed or previously deployed) is significantly higher among women than men, raising the possibility of gender differences in the adverse psychological effects of deployment.
  
  
  METHODS
  Person-month survival models based on a consolidated administrative database for active duty enlisted Regular Army soldiers in 2004-2009 (n = 975,057) were used to characterize the gender × deployment interaction predicting suicide. Four explanatory hypotheses were explored involving the proportion of females in each soldier's occupation, the proportion of same-gender soldiers in each soldier's unit, whether the soldier reported sexual assault victimization in the previous 12 months, and the soldier's pre-deployment history of treated mental/behavioral disorders.
  
  
  RESULTS
  The suicide rate of currently deployed women (14.0/100,000 person-years) was 3.1-3.5 times the rates of other (i.e. never-deployed/previously deployed) women. The suicide rate of currently deployed men (22.6/100,000 person-years) was 0.9-1.2 times the rates of other men. The adjusted (for time trends, sociodemographics, and Army career variables) female:male odds ratio comparing the suicide rates of currently deployed v. other women v. men was 2.8 (95% confidence interval 1.1-6.8), became 2.4 after excluding soldiers with Direct Combat Arms occupations, and remained elevated (in the range 1.9-2.8) after adjusting for the hypothesized explanatory variables.
  
  
  CONCLUSIONS
  These results are valuable in excluding otherwise plausible hypotheses for the elevated suicide rate of deployed women and point to the importance of expanding future research on the psychological challenges of deployment for women.
authors.affiliation: National Center for PTSD, VA Boston Healthcare System,Boston,MA,USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Street
authors.affiliation: Departments of Social and Behavioral Sciences, and Epidemiology,Harvard School of Public Health,Boston,MA,USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Gilman
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston,MA,USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Rosellini
authors.affiliation: Departments of Psychiatry and Family and Preventive Medicine,University of California San Diego,La Jolla,CA,USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Stein
authors.affiliation: Department of Psychiatry,Stony Brook University School of Medicine,Stony Brook,NY,USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Bromet
authors.affiliation: US Army Public Health Command,Aberdeen Proving Ground,MD,USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Cox
authors.affiliation: Division of Services and Intervention Research, National Institute of Mental Health,Bethesda,MD,USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Colpe
authors.affiliation: Department of Psychiatry,Uniformed Services University School of Medicine,Center for the Study of Traumatic Stress,Bethesda,MD,USA.
authors.forename: C S
authors.initials: CS
authors.lastname: Fullerton
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston,MA,USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Gruber
authors.affiliation: Institute for Social Research, University of Michigan,Ann Arbor,MI,USA.
authors.forename: S G
authors.initials: SG
authors.lastname: Heeringa
authors.affiliation: Institute for Social Research, University of Michigan,Ann Arbor,MI,USA.
authors.forename: L
authors.initials: L
authors.lastname: Lewandowski-Romps
authors.affiliation: Department of Biostatistics,University of Michigan,Ann Arbor,MI,USA.
authors.forename: R J A
authors.initials: RJ
authors.lastname: Little
authors.affiliation: Department of Psychiatry,Uniformed Services University School of Medicine,Center for the Study of Traumatic Stress,Bethesda,MD,USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Naifeh
authors.affiliation: Department of Psychology,Harvard University,Cambridge,MA,USA.
authors.forename: M K
authors.initials: MK
authors.lastname: Nock
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston,MA,USA.
authors.forename: N A
authors.initials: NA
authors.lastname: Sampson
authors.affiliation: Office of Science Policy,Planning and Communications,National Institute of Mental Health,Bethesda,MD,USA.
authors.forename: M
authors.initials: M
authors.lastname: Schoenbaum
authors.affiliation: Department of Psychiatry,Uniformed Services University School of Medicine,Center for the Study of Traumatic Stress,Bethesda,MD,USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Ursano
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston,MA,USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Zaslavsky
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston,MA,USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D012306:Risk; D012737:Sex Factors; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D059030:United States Department of Defense / Q000706:statistics & numerical data
keywords: suicide