title: Frequency of Improvised Explosive Devices and Suicide Attempts in the U.S. Army.
abstract: Improvised explosive devices (IEDs) were a prominent and initially new threat in the Iraq and Afghanistan war which raised concerns and anticipatory fear in and out of theater. This study examined the association of monthly IED rates with risk of soldier suicide attempt among those deployed and nondeployed.
  
  
  
  Person-month records for all active duty Regular Army suicide attempters from 2004 through 2009 (n = 9,791) and an equal-probability sample of control person-months (n = 183,826) were identified. Logistic regression analyses examined soldiers' risk of attempting suicide as a function of monthly IED frequency, controlling for sociodemographics, service-related characteristics, rate of deployment/redeployment, and combat deaths and injuries. The association of IED frequency with suicide attempt was examined overall and by time in service and deployment status.
  
  
  
  Soldiers' risk of suicide attempt increased with increasing numbers of IEDs. Suicide attempt was 26% more likely for each 1,000 IED increase in monthly frequency (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.22-1.30). The association of IED frequency with suicide attempt was greater for soldiers in their first 2 years of service (OR = 1.30, 95% CI = 1.25-1.36) than for those with 3 or more years of service (OR = 1.18, 95% CI = 1.12-1.24). Among soldiers in their first 2 years of service, the association was constant, regardless of deployment status (χ22= 3.89, p = 0.14). Among soldiers with 3 or more years of service, the association was higher for those never deployed (OR = 1.12, 95% CI = 1.01-1.24) and currently deployed (OR = 1.14, 95% CI = 1.05-1.23) than for those previously deployed.
  
  
  
  To our knowledge, this is the first study to examine and demonstrate an association between the aggregate frequency of IEDs and risk of suicide attempts among U.S. Army soldiers. This association was observed across deployment status and time in service, and for early-career soldiers in particular. The findings suggest that the threat of new weapons may increase stress burden among soldiers. Targeting risk perception and perceived preparedness, particularly early in a soldier's career, may improve psychological resilience and reduce suicide risk.
authors.affiliation: Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Ursano
authors.affiliation: Department of Health Care Policy, Harvard Medical School, 180A Longwood Avenue, Boston, MA 02115.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
authors.affiliation: Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: James A
authors.initials: JA
authors.lastname: Naifeh
authors.affiliation: Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Holly Herberman
authors.initials: HH
authors.lastname: Mash
authors.affiliation: Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Carol S
authors.initials: CS
authors.lastname: Fullerton
authors.affiliation: Darla School of Business, University of South Carolina, 1014 Greene Street, Columbia, SC 29208.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Bliese
authors.affiliation: Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Gary H
authors.initials: GH
authors.lastname: Wynn
authors.affiliation: Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Pablo A
authors.initials: PA
authors.lastname: Aliaga
authors.affiliation: Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Christina
authors.initials: C
authors.lastname: Wryter
authors.affiliation: Department of Health Care Policy, Harvard Medical School, 180A Longwood Avenue, Boston, MA 02115.
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, 4301 Jones Bridge road, Bethesda, MD 20814.
authors.forename: Tzu-Cheg
authors.initials: TC
authors.lastname: Kao
authors.affiliation: National Institute of Mental Health, 6001 Executive Boulevard, Rockville, MD 20852.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Colpe
authors.affiliation: U.S. Army Public Health Command, Army Public Health Center, 5158 Blackhawk Road, Aberdeen Proving Ground, MD 21010.
authors.forename: Michael
authors.initials: M
authors.lastname: Schoenbaum
authors.affiliation: University of Michigan, Institute for Social Research, 426 Thompson Street, Ann Arbor, MI 48104.
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Cox
authors.affiliation: Department of Psychiatry and Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Heeringa
authors.affiliation: VA San Diego Healthcare System, 3350 La Jolla Village Drive, La Jolla, CA 92161.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D053834:Explosive Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D016015:Logistic Models; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D016017:Odds Ratio; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*; D023481:Terrorism / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D053834:Explosive Agents