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Occupational differences in US Army suicide rates

Published online by Cambridge University Press:  20 July 2015

R. C. Kessler*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
M. B. Stein
Affiliation:
Departments of Psychiatry and Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA VA San Diego Healthcare System, San Diego, CA, USA
P. D. Bliese
Affiliation:
Darla Moore School of Business, University of South Carolina, Columbia, SC, USA
E. J. Bromet
Affiliation:
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
W. T. Chiu
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
K. L. Cox
Affiliation:
US Army Public Health Command, Aberdeen Proving Ground, MD, USA
L. J. Colpe
Affiliation:
Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD, USA
C. S. Fullerton
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
S. E. Gilman
Affiliation:
Departments of Social and Behavioral Sciences, and Epidemiology, Harvard School of Public Health, Boston, MA, USA
M. J. Gruber
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
S. G. Heeringa
Affiliation:
Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
L. Lewandowski-Romps
Affiliation:
Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
A. Millikan-Bell
Affiliation:
US Army Public Health Command, Aberdeen Proving Ground, MD, USA
J. A. Naifeh
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
M. K. Nock
Affiliation:
Department of Psychology, Harvard University, Cambridge, MA, USA
M. V. Petukhova
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
A. J. Rosellini
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
N. A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
M. Schoenbaum
Affiliation:
Office of Science Policy, Planning and Communications, National Institute of Mental Health, Bethesda, MD, USA
A. M. Zaslavsky
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
R. J. Ursano
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
*
*Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. (Email: kessler@hcp.med.harvard.edu)

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.

Method

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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2015 

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