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Sociodemographic and career history predictors of suicide mortality in the United States Army 2004–2009

  • S. E. Gilman (a1), E. J. Bromet (a2), K. L. Cox (a3), L. J. Colpe (a4), C. S. Fullerton (a5), M. J. Gruber (a6), S. G. Heeringa (a7), L. Lewandowski-Romps (a7), A. M. Millikan-Bell (a3), J. A. Naifeh (a5), M. K. Nock (a8), M. V. Petukhova (a6), N. A. Sampson (a6), M. Schoenbaum (a9), M. B. Stein (a10) (a11), R. J. Ursano (a5), S. Wessely (a12), A. M. Zaslavsky (a6) and R. C. Kessler (a6)...



The US Army suicide rate has increased sharply in recent years. Identifying significant predictors of Army suicides in Army and Department of Defense (DoD) administrative records might help focus prevention efforts and guide intervention content. Previous studies of administrative data, although documenting significant predictors, were based on limited samples and models. A career history perspective is used here to develop more textured models.


The analysis was carried out as part of the Historical Administrative Data Study (HADS) of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). De-identified data were combined across numerous Army and DoD administrative data systems for all Regular Army soldiers on active duty in 2004–2009. Multivariate associations of sociodemographics and Army career variables with suicide were examined in subgroups defined by time in service, rank and deployment history.


Several novel results were found that could have intervention implications. The most notable of these were significantly elevated suicide rates (69.6–80.0 suicides per 100 000 person-years compared with 18.5 suicides per 100 000 person-years in the total Army) among enlisted soldiers deployed either during their first year of service or with less than expected (based on time in service) junior enlisted rank; a substantially greater rise in suicide among women than men during deployment; and a protective effect of marriage against suicide only during deployment.


A career history approach produces several actionable insights missed in less textured analyses of administrative data predictors. Expansion of analyses to a richer set of predictors might help refine understanding of intervention implications.


Corresponding author

* Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. (Email:


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Armed Forces Health Surveillance Center (2012). Deaths while on active duty in the U.S. Armed Forces, 1990–2011. Medical Surveillance Monthly Reports 19, 25.
Bachynski, KE, Canham-Chervak, M, Black, SA, Dada, EO, Millikan, AM, Jones, BH (2012). Mental health risk factors for suicides in the US Army, 2007–8. Injury Prevention 18, 405412.
Bell, NS, Harford, TC, Amoroso, PJ, Hollander, IE, Kay, AB (2010). Prior health care utilization patterns and suicide among U.S. Army soldiers. Suicide and Life-Threatening Behavior 40, 407415.
Black, SA, Gallaway, MS, Bell, MR, Ritchie, EC (2011). Prevalence and risk factors associated with suicides of army soldiers 2001–2009. Military Psychology 23, 433451.
Bond, EF (2004). Women's physical and mental health sequellae of wartime service. Nursing Clinics of North America 39, 5368.
Bush, NE, Reger, MA, Luxton, DD, Skopp, NA, Kinn, J, Smolenski, D, Gahm, GA (2013). Suicides and suicide attempts in the U.S. Military, 2008–2010. Suicide and Life-Threatening Behavior 43, 262273.
Drummet, AR, Coleman, M, Cable, S (2003). Military families under stress: implications for family life education. Family Relations 52, 279287.
Fergusson, DM, Woodward, LJ, Horwood, LJ (2000). Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood. Psychological Medicine 30, 2339.
Gradus, JL, Shipherd, JC, Suvak, MK, Giasson, HL, Miller, M (2013). Suicide attempts and suicide among Marines: a decade of follow-up. Suicide and Life-Threatening Behavior 43, 3949.
Gunnell, D, Lewis, G (2005). Studying suicide from the life course perspective: implications for prevention. British Journal of Psychiatry 187, 206208.
Hanley, JA (2001). A heuristic approach to the formulas for population attributable fraction. Journal of Epidemiology and Community Health 55, 508514.
Harvey, SB, Hatch, SL, Jones, M, Hull, L, Jones, N, Greenberg, N, Dandeker, C, Fear, NT, Wessely, S (2012). The long-term consequences of military deployment: a 5-year cohort study of United Kingdom reservists deployed to Iraq in 2003. American Journal of Epidemiology 176, 11771184.
Hoge, CW, Auchterlonie, JL, Milliken, CS (2006). Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. Journal of the American Medical Association 295, 10231032.
Hyman, J, Ireland, R, Frost, L, Cottrell, L (2012). Suicide incidence and risk factors in an active duty US military population. American Journal of Public Health 102 (Suppl. 1), S138S146.
Ireland, RR, Kress, AM, Frost, LZ (2012). Association between mental health conditions diagnosed during initial eligibility for military health care benefits and subsequent deployment, attrition, and death by suicide among active duty service members. Military Medicine 177, 11491156.
Kang, H, Dalager, N, Mahan, C, Ishii, E (2005). The role of sexual assault on the risk of PTSD among Gulf War veterans. Annals of Epidemiology 15, 191195.
Kessler, RC, Colpe, LJ, Fullerton, CS, Gebler, N, Naifeh, JA, Nock, MK, Sampson, NA, Schoenbaum, M, Zaslavsky, AM, Stein, MB, Ursano, RJ, Heeringa, SG (2013). Design of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). International Journal of Methods in Psychiatric Research 22, 267275.
Kposowa, AJ (2000). Marital status and suicide in the National Longitudinal Mortality Study. Journal of Epidemiology and Community Health 54, 254261.
Kuehn, BM (2009). Soldier suicide rates continue to rise: military, scientists work to stem the tide. Journal of the American Medical Association 301, 11111113.
La Bash, HA, Vogt, DS, King, LA, King, DW (2009). Deployment stressors of the Iraq War: insights from the mainstream media. Journal of Interpersonal Violence 24, 231258.
LeardMann, CA, Powell, TM, Smith, TC, Bell, MR, Smith, B, Boyko, EJ, Hooper, TI, Gackstetter, GD, Ghamsary, M, Hoge, CW (2013). Risk factors associated with suicide in current and former US military personnel. Journal of the American Medical Association 310, 496506.
Logan, J, Skopp, NA, Karch, D, Reger, MA, Gahm, GA (2012). Characteristics of suicides among US Army active duty personnel in 17 US states from 2005 to 2007. American Journal of Public Health 102 (Suppl. 1), S40S44.
MacGregor, AJ, Han, PP, Dougherty, AL, Galarneau, MR (2012). Effect of dwell time on the mental health of US military personnel with multiple combat tours. American Journal of Public Health 102 (Suppl. 1), S55S59.
Maniglio, R (2011). The role of child sexual abuse in the etiology of suicide and non-suicidal self-injury. Acta Psychiatrica Scandinavica 124, 3041.
Mittendorfer-Rutz, E, Rasmussen, F, Lange, T (2012). A life-course study on effects of parental markers of morbidity and mortality on offspring's suicide attempt. PLOS ONE 7, e51585.
Nock, MK, Borges, G, Bromet, EJ, Cha, CB, Kessler, RC, Lee, S (2008). Suicide and suicidal behavior. Epidemiologic Reviews 30, 133154.
Reger, MA, Gahm, GA, Swanson, RD, Duma, SJ (2009). Association between number of deployments to Iraq and mental health screening outcomes in US Army soldiers. Journal of Clinical Psychiatry 70, 12661272.
Riordan, DV, Selvaraj, S, Stark, C, Gilbert, JS (2006). Perinatal circumstances and risk of offspring suicide. Birth cohort study. British Journal of Psychiatry 189, 502507.
Ritchie, EC (2012). Suicide and the United States Army: perspectives from the former psychiatry consultant to the Army Surgeon General. Cerebrum. ( Accessed 15 November 2013.
Riviere, LA, Merrill, JC, Thomas, JL, Wilk, JE, Bliese, PD (2012). 2003–2009 marital functioning trends among U.S. enlisted soldiers following combat deployments. Military Medicine 177, 11691177.
Roalfe, AK, Holder, RL, Wilson, S (2008). Standardisation of rates using logistic regression: a comparison with the direct method. BMC Health Services Research 8, 275.
Rockett, IR, Regier, MD, Kapusta, ND, Coben, JH, Miller, TR, Hanzlick, RL, Todd, KH, Sattin, RW, Kennedy, LW, Kleinig, J, Smith, GS (2012). Leading causes of unintentional and intentional injury mortality: United States, 2000–2009. American Journal of Public Health 102, e84e92.
Rona, RJ, Fear, NT, Hull, L, Greenberg, N, Earnshaw, M, Hotopf, M, Wessely, S (2007). Mental health consequences of overstretch in the UK armed forces: first phase of a cohort study. British Medical Journal 335, 603.
Rothman, K, Greenland, S (1998). Modern Epidemiology, 2nd edn. Lippincott Williams and Wilkins: Philadelphia.
Schlesselman, JJ (1982). Case-control Studies: Design, Conduct, Analysis. Oxford University Press: New York.
Schoenbaum, M, Kessler, RC, Gilman, SE, Colpe, LJ, Heeringa, SG, Stein, MB, Ursano, RJ, Cox, KL (in press). Predictors of suicide and accident death in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). JAMA Psychiatry.
Seguin, M, Lesage, A, Turecki, G, Bouchard, M, Chawky, N, Tremblay, N, Daigle, F, Guy, A (2007). Life trajectories and burden of adversity: mapping the developmental profiles of suicide mortality. Psychological Medicine 37, 15751583.
Shen, YC, Arkes, J, Williams, TV (2012). Effects of Iraq/Afghanistan deployments on major depression and substance use disorder: analysis of active duty personnel in the US military. American Journal of Public Health 102 (Suppl. 1), S80S87.
Sheppard, SC, Malatras, JW, Israel, AC (2010). The impact of deployment on U.S. military families. American Psychologist 65, 599609.
Shiner, M, Scourfield, J, Fincham, B, Langer, S (2009). When things fall apart: gender and suicide across the life-course. Social Science and Medicine 69, 738746.
Street, AE, Vogt, D, Dutra, L (2009). A new generation of women veterans: stressors faced by women deployed to Iraq and Afghanistan. Clinical Psychology Review 29, 685694.
Thomsen, CJ, Stander, VA, McWhorter, SK, Rabenhorst, MM, Milner, JS (2011). Effects of combat deployment on risky and self-destructive behavior among active duty military personnel. Journal of Psychiatric Research 45, 13211331.
Vogt, D, Vaughn, R, Glickman, ME, Schultz, M, Drainoni, ML, Elwy, R, Eisen, S (2011). Gender differences in combat-related stressors and their association with postdeployment mental health in a nationally representative sample of U.S. OEF/OIF veterans. Journal of Abnormal Psychology 120, 797806.
Vogt, DS, Pless, AP, King, LA, King, DW (2005). Deployment stressors, gender, and mental health outcomes among Gulf War I veterans. Journal of Traumatic Stress 18, 272284.
Warner, CH, Appenzeller, GN, Parker, JR, Warner, CM, Hoge, CW (2011). Effectiveness of mental health screening and coordination of in-theater care prior to deployment to Iraq: a cohort study. American Journal of Psychiatry 168, 378385.
Willett, JB, Singer, JD (1993). Investigating onset, cessation, relapse, and recovery: why you should, and how you can, use discrete-time survival analysis to examine event occurrence. Journal of Consulting Clinical Psychology 61, 952965.
Woodhead, C, Wessely, S, Jones, N, Fear, NT, Hatch, SL (2012). Impact of exposure to combat during deployment to Iraq and Afghanistan on mental health by gender. Psychological Medicine 42, 19851996.


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Sociodemographic and career history predictors of suicide mortality in the United States Army 2004–2009

  • S. E. Gilman (a1), E. J. Bromet (a2), K. L. Cox (a3), L. J. Colpe (a4), C. S. Fullerton (a5), M. J. Gruber (a6), S. G. Heeringa (a7), L. Lewandowski-Romps (a7), A. M. Millikan-Bell (a3), J. A. Naifeh (a5), M. K. Nock (a8), M. V. Petukhova (a6), N. A. Sampson (a6), M. Schoenbaum (a9), M. B. Stein (a10) (a11), R. J. Ursano (a5), S. Wessely (a12), A. M. Zaslavsky (a6) and R. C. Kessler (a6)...


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