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Undetected suicide attempts among U.S. soldiers: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

Published online by Cambridge University Press:  25 September 2024

James A. Naifeh Open the ORCID record for James A. Naifeh [Opens in a new window] ,
Robert J. Ursano Open the ORCID record for Robert J. Ursano [Opens in a new window] ,
Rachel Shor ,
Holly B. Herberman Mash ,
Pablo A. Aliaga ,
Carol S. Fullerton ,
Matthew K. Nock ,
Tzu-Cheg Kao ,
Nancy A. Sampson  and
Ronald C. Kessler
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James A. Naifeh
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
Robert J. Ursano*
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
Rachel Shor
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
Holly B. Herberman Mash
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
Pablo A. Aliaga
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
Carol S. Fullerton
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
Matthew K. Nock
Affiliation:
Department of Psychology, Harvard University, Cambridge, MA, USA
Tzu-Cheg Kao
Affiliation:
Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
Nancy A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Ronald C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Murray B. Stein
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA VA San Diego Healthcare System, San Diego, CA, USA
*
Corresponding author: Robert J. Ursano; Email: robert.ursano@usuhs.edu
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Abstract

Background

While previous studies have reported high rates of documented suicide attempts (SAs) in the U.S. Army, the extent to which soldiers make SAs that are not identified in the healthcare system is unknown. Understanding undetected suicidal behavior is important in broadening prevention and intervention efforts.

Methods

Representative survey of U.S. Regular Army enlisted soldiers (n = 24 475). Reported SAs during service were compared with SAs documented in administrative medical records. Logistic regression analyses examined sociodemographic characteristics differentiating soldiers with an undetected SA v. documented SA. Among those with an undetected SA, chi-square tests examined characteristics associated with receiving a mental health diagnosis (MH-Dx) prior to SA. Discrete-time survival analysis estimated risk of undetected SA by time in service.

Results

Prevalence of undetected SA (unweighted n = 259) was 1.3%. Annual incidence was 255.6 per 100 000 soldiers, suggesting one in three SAs are undetected. In multivariable analysis, rank ⩾E5 (OR = 3.1[95%CI 1.6–5.7]) was associated with increased odds of undetected v. documented SA. Females were more likely to have a MH-Dx prior to their undetected SA (Rao-Scott χ 21 = 6.1, p = .01). Over one-fifth of undetected SAs resulted in at least moderate injury. Risk of undetected SA was greater during the first four years of service.

Conclusions

Findings suggest that substantially more soldiers make SAs than indicated by estimates based on documented attempts. A sizable minority of undetected SAs result in significant injury. Soldiers reporting an undetected SA tend to be higher ranking than those with documented SAs. Undetected SAs require additional approaches to identifying individuals at risk.

Keywords

suicide attemptmilitaryself-reportdiagnosismedical records
Type
Original Article
Information
Psychological Medicine , Volume 54 , Issue 11 , August 2024 , pp. 2947 - 2955
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Copyright
Copyright © Uniformed Services University of the Health Sciences, US Department of Defense, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Harvard University, and University of California San Diego, 2024. To the extent this is a work of the US Government, it is not subject to copyright protection within the United States. Published by Cambridge University Press

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