title: Occupational differences in US Army suicide rates.
abstract: BACKGROUND
  Civilian suicide rates vary by occupation in ways related to occupational stress exposure. Comparable military research finds suicide rates elevated in combat arms occupations. However, no research has evaluated variation in this pattern by deployment history, the indicator of occupation stress widely considered responsible for the recent rise in the military suicide rate.
  
  
  METHODS
  The joint associations of Army occupation and deployment history in predicting suicides were analysed in an administrative dataset for the 729 337 male enlisted Regular Army soldiers in the US Army between 2004 and 2009.
  
  
  RESULTS
  There were 496 suicides over the study period (22.4/100 000 person-years). Only two occupational categories, both in combat arms, had significantly elevated suicide rates: infantrymen (37.2/100 000 person-years) and combat engineers (38.2/100 000 person-years). However, the suicide rates in these two categories were significantly lower when currently deployed (30.6/100 000 person-years) than never deployed or previously deployed (41.2-39.1/100 000 person-years), whereas the suicide rate of other soldiers was significantly higher when currently deployed and previously deployed (20.2-22.4/100 000 person-years) than never deployed (14.5/100 000 person-years), resulting in the adjusted suicide rate of infantrymen and combat engineers being most elevated when never deployed [odds ratio (OR) 2.9, 95% confidence interval (CI) 2.1-4.1], less so when previously deployed (OR 1.6, 95% CI 1.1-2.1), and not at all when currently deployed (OR 1.2, 95% CI 0.8-1.8). Adjustment for a differential 'healthy warrior effect' cannot explain this variation in the relative suicide rates of never-deployed infantrymen and combat engineers by deployment status.
  
  
  CONCLUSIONS
  Efforts are needed to elucidate the causal mechanisms underlying this interaction to guide preventive interventions for soldiers at high suicide risk.
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston,MA,USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Kessler
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: Darla Moore School of Business,University of South Carolina,Columbia,SC,USA.
authors.forename: P D
authors.initials: PD
authors.lastname: Bliese
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: Department of Health Care Policy,Harvard Medical School,Boston,MA,USA.
authors.forename: W T
authors.initials: WT
authors.lastname: Chiu
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: Center for the Study of Traumatic Stress,Department of Psychiatry,Uniformed Services University School of Medicine,Bethesda,MD,USA.
authors.forename: C S
authors.initials: CS
authors.lastname: Fullerton
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: 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: US Army Public Health Command,Aberdeen Proving Ground,MD,USA.
authors.forename: A
authors.initials: A
authors.lastname: Millikan-Bell
authors.affiliation: Center for the Study of Traumatic Stress,Department of Psychiatry,Uniformed Services University School of Medicine,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: M V
authors.initials: MV
authors.lastname: Petukhova
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: 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 Health Care Policy,Harvard Medical School,Boston,MA,USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Zaslavsky
authors.affiliation: Center for the Study of Traumatic Stress,Department of Psychiatry,Uniformed Services University School of Medicine,Bethesda,MD,USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Ursano
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D009790:Occupations / Q000706:statistics & numerical data; D055500:Resilience, Psychological; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D059030:United States Department of Defense / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Army; Army STARRS; deployment; resiliency factors; suicide