title: Risk Factors, Methods, and Timing of Suicide Attempts Among US Army Soldiers.
abstract: Suicide attempts in the US Army have risen in the past decade. Understanding the association between suicide attempts and deployment, as well as method and timing of suicide attempts, can assist in developing interventions.
  
  
  
  To examine suicide attempt risk factors, methods, and timing among soldiers currently deployed, previously deployed, and never deployed at the time this study was conducted.
  
  
  
  This longitudinal, retrospective cohort study of Regular Army-enlisted soldiers on active duty from 2004 through 2009 used individual-level person-month records to examine risk factors (sociodemographic, service related, and mental health), method, and time of suicide attempt by deployment status (never, currently, and previously deployed). Administrative data for the month before each of 9650 incident suicide attempts and an equal-probability sample of 153 528 control person-months for other soldiers were analyzed using a discrete-time survival framework.
  
  
  
  Suicide attempts and career, mental health, and demographic predictors were obtained from administrative and medical records.
  
  
  
  Of the 9650 enlisted soldiers who attempted suicide, 86.3% were male, 68.4% were younger than 30 years, 59.8% were non-Hispanic white, 76.5% were high school educated, and 54.7% were currently married. The 40.4% of enlisted soldiers who had never been deployed (n = 12 421 294 person-months) accounted for 61.1% of enlisted soldiers who attempted suicide (n = 5894 cases). Risk among those never deployed was highest in the second month of service (103 per 100 000 person-months). Risk among soldiers on their first deployment was highest in the sixth month of deployment (25 per 100 000 person-months). For those previously deployed, risk was highest at 5 months after return (40 per 100 000 person-months). Currently and previously deployed soldiers were more likely to attempt suicide with a firearm than those never deployed (currently deployed: OR, 4.0; 95% CI, 2.9-5.6; previously deployed: OR, 2.7; 95% CI, 1.8-3.9). Across deployment status, suicide attempts were more likely among soldiers who were women (currently deployed: OR, 3.4; 95% CI, 3.0-4.0; previously deployed: OR, 1.5; 95% CI, 1.4-1.7; and never deployed: OR, 2.4; 95% CI, 2.3-2.6), in their first 2 years of service (currently deployed: OR, 1.9; 95% CI, 1.5-2.3; previously deployed: OR, 2.2; 95% CI, 1.9-2.7; and never deployed: OR, 3.1; 95% CI, 2.7-3.6), and had a recently received a mental health diagnosis in the previous month (currently deployed: OR, 29.8; 95% CI, 25.0-35.5; previously deployed: OR, 22.2; 95% CI, 20.1-24.4; and never deployed: OR, 15.0; 95% CI, 14.2-16.0). Among soldiers with 1 previous deployment, odds of a suicide attempt were higher for those who screened positive for depression or posttraumatic stress disorder after return from deployment and particularly at follow-up screening, about 4 to 6 months after deployment (depression: OR, 1.4; 95% CI, 1.1-1.9; posttraumatic stress disorder: OR, 2.4; 95% CI, 2.1-2.8).
  
  
  
  Identifying the timing and risk factors for suicide attempt in soldiers requires consideration of environmental context, individual characteristics, and mental health. These factors can inform prevention efforts.
authors.affiliation: Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Ursano
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
authors.affiliation: Department of Psychiatry, University of California-San Diego, La Jolla4Department of Family Medicine and Public Health, University of California-San Diego, La Jolla.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
authors.affiliation: Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: James A
authors.initials: JA
authors.lastname: Naifeh
authors.affiliation: Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Pablo A
authors.initials: PA
authors.lastname: Aliaga
authors.affiliation: Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Carol S
authors.initials: CS
authors.lastname: Fullerton
authors.affiliation: Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Gary H
authors.initials: GH
authors.lastname: Wynn
authors.affiliation: Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Patti L
authors.initials: PL
authors.lastname: Vegella
authors.affiliation: Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Tsz Hin Hinz
authors.initials: TH
authors.lastname: Ng
authors.affiliation: Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Bailey G
authors.initials: BG
authors.lastname: Zhang
authors.affiliation: Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Christina L
authors.initials: CL
authors.lastname: Wryter
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Sampson
authors.affiliation: Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Tzu-Cheg
authors.initials: TC
authors.lastname: Kao
authors.affiliation: University of California-San Diego, La Jolla7Veterans Affairs San Diego Healthcare System, La Jolla, California8National Institute of Mental Health, Bethesda, Maryland.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Colpe
authors.affiliation: University of California-San Diego, La Jolla7Veterans Affairs San Diego Healthcare System, La Jolla, California8National Institute of Mental Health, Bethesda, Maryland.
authors.forename: Michael
authors.initials: M
authors.lastname: Schoenbaum
authors.affiliation: Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: James E
authors.initials: JE
authors.lastname: McCarroll
authors.affiliation: US Army Public Health Command, Aberdeen Proving Ground, Maryland.
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Cox
authors.affiliation: University of Michigan, Institute for Social Research, Ann Arbor.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Heeringa
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D002423:Cause of Death; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008403:Mass Screening; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology* / Q000706:statistics & numerical data*; D013997:Time Factors