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Suicide Risk Factors in the US Army: A Longitudinal Cohort Study

Adverse events within an army unit, such as suicidal events, can affect the mental health of the unit’s soldiers. A recent study examined suicide risk factors in the US Army and found with an increase of past suicide attempts within a unit, there is an increased risk of suicide attempts among soldiers.

Army units are an integral part of a soldier’s experience. Together in a unit, soldiers share common stressors such as training, bullying, combat, and injury which can have a negative impact on their mental well-being. Of interest is the effect exposure to suicidal behaviors has on those within the community, a phenomenon known as suicide contagion. As it has not yet been systematically assessed, a longitudinal cohort study in JAMA Psychiatry examined a time period in the Iraq and Afghanistan wars to determine whether a history of suicide attempts in an army unit influences the risk of suicide attempts, and how other individual and unit characteristics relate to this risk.

Data was taken from the Army Study to Assess Risk and Resilience in
Service members (STARRS) Historical Administrative Data Study (HADS), which has data on active duty soldiers from January 1, 2004, to December 31, 2009, as well as the US Army and US Department of Defense administration records to identify those who attempted suicide. A total of 9,512 enlisted soldiers who attempted suicide were used as the sample group. Excluded were person-months with a large unit size (greater than 600 soldiers) and person-months unlinked to a unit. Altogether, 151 526 control person-months were selected excluding soldiers with logged non-lethal suicidal events or suicide attempts and person-months with soldier deaths. In total 86.4% of individuals were males, 68.4% of individuals were younger than 30, 59.8% were white and 62.6% were under 21 years of age when they joined the army.

The analysis showed that as the past-year number of suicide attempts in a unit increased, the chances of a soldier committing suicide increased (the odds ratio for a unit with 1 past-year suicide attempt was 1.6 vs 3.9 in a unit with at least 5 past-year suicide attempts). When adjusted for variables such as occupation unit size and age at army entry, there was still the same relationship. The association was also examined by excluding soldiers undergoing rehabilitation for significant physical or mental health issues, new soldiers (due to their high suicide risk) and by looking at the number of past-year suicide attempters in a unit. With each of these adjustments, the results remained the same; there was an increase in the likelihood of suicide attempts in units with past-year suicide attempts.

When looking at other variables, the number of suicide attempts was not affected by deaths by suicide, combat or unintentional injuries in the past year within a unit, but it was influenced by prior mental health diagnosis.The data was stratified by occupation and found that for all occupations within the army, as the number of past-year suicide attempts increased, the likelihood of suicide attempts increased as well, but the risk was higher for combat arms soldiers in a unit with at least 5 past-year suicide attempts compared to other occupations. It was also found that for each unit size, as the number of past-year suicide attempts increased, the odds of suicide attempts increased as well, with a stronger relationship in units with 1-40 soldiers.

In conclusion, previous suicide attempts in an army unit is a risk factor for suicide attempts among soldiers, with the relationship being stronger in smaller units. Within this study lie several limitations. First, it is possible the records from which the data was acquired only included the severe cases of suicide attempts and is not a true representation of all suicide attempts. Also, the time range chosen for the study limits the ability to generalize to parts of the war and military conflict outside of this time frame. In the future, it would be beneficial to examine the effect of factors such as leadership quality, unit cohesion, and how recently the suicide attempts occurred within army units. In all, providing ample support to soldiers after these incidents may be beneficial for recovery and prevention of future suicides.

Written by Monica Naatey-Ahumah


Ursano, R.J., Kessler, R.C., Naifeh, J.A., Herberman Mash, H., Fullerton, C.S., Bliese, P.D.,
Zaslavsky, A.M., … & Stein, M.B. (2017). Risk of Suicide Attempt Among Soldiers in Army Units With a History of Suicide Attempts. JAMA Psychiatry, Retrieved August 6, 2017, from

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