Nonfatal Suicidal Behaviors in the Administrative Records of Activated U.S. Army National Guard and Army Reserve Soldiers, 2004–2009

Abstract

Objective: The U.S. Army suicide rate increased sharply during the wars in Iraq and Afghanistan. There is limited information about medically documented, nonfatal suicidal behaviors among soldiers in the Army’s Reserve Component (RC), which is composed of the Army National Guard and Army Reserve. Here we examine trends and sociodemographic correlates of suicide attempts, suspicious injuries, and suicide ideation among activated RC soldiers. Methods: Data come from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) Historical Administrative Data Study (HADS), which integrates administrative records for all soldiers on active duty for the years 2004 through 2009 (n = 1.66 million). Results: We identified 2,937 unique RC soldiers on active duty with a nonfatal suicidal event documented at some point during the HADS study period. There were increases in the annual incidence rates of suicide attempts (71 to 204/100,000 person-years) and suicide ideation (326 to 425/100,000 person-years). Incidence rates for suspicious injuries also generally increased but were more variable. Using hierarchical classification rules, we identified the first instance of each soldier’s most severe behavior (suicide attempt versus suspicious injury versus suicide ideation). For each of those suicide- or injury-related outcomes, we found increased risk among those who were female, younger, non-Hispanic White, less educated, never married, and lower-ranking enlisted. These sociodemographic associations significantly differed across outcomes, although the patterns were similar. Conclusion: Results provide a broad overview of nonfatal suicidal trends in the RC during the period 2004 through 2009. They also demonstrate that integration of multiple administrative data systems enriches analysis of the predictors of such events.

Acknowledgments

The Army STARRS Team consists of the following individuals:

• Coprincipal investigators: Robert J. Ursano, MD (Uniformed Services University of the Health Sciences), and Murray B. Stein, MD, MPH (University of California San Diego and VA San Diego Healthcare System)

• Site principal investigators: Steven Heeringa, PhD (University of Michigan), and Ronald C. Kessler, PhD (Harvard Medical School)

• Army liaison/consultant: Kenneth Cox, MD, MPH (U.S. Army Public Health Center)

• Other team members: Pablo A. Aliaga, MS (Uniformed Services University of the Health Sciences); COL David M. Benedek, MD (Uniformed Services University of the Health Sciences); Susan Borja, PhD (NIMH); Laura Campbell-Sills, PhD (University of California San Diego); Carol S. Fullerton, PhD (Uniformed Services University of the Health Sciences); Nancy Gebler, MA (University of Michigan); Robert K. Gifford, PhD (Uniformed Services University of the Health Sciences); Paul E. Hurwitz, MPH (Uniformed Services University of the Health Sciences); Sonia Jain, PhD (University of California San Diego); Tzu-Cheg Kao, PhD (Uniformed Services University of the Health Sciences); Lisa Lewandowski-Romps, PhD (University of Michigan); Holly Herberman Mash, PhD (Uniformed Services University of the Health Sciences); James E. McCarroll, PhD, MPH (Uniformed Services University of the Health Sciences); James A. Naifeh, PhD (Uniformed Services University of the Health Sciences); Tsz Hin Hinz Ng, MPH (Uniformed Services University of the Health Sciences); Matthew K. Nock, PhD (Harvard University); Nancy A. Sampson, BA (Harvard Medical School); CDR Patcho Santiago, MD, MPH (Uniformed Services University of the Health Sciences); LTC Gary H. Wynn, MD (Uniformed Services University of the Health Sciences); and Alan M. Zaslavsky, PhD (Harvard Medical School).

Additional information

Funding

Army STARRS was sponsored by the U.S. Department of the Army and funded under cooperative agreement number U01MH087981 (2009–2015) with the U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health (NIH/NIMH). Subsequently, STARRS-LS was sponsored and funded by the U.S. Department of Defense (USUHS grant number HU0001-15-2-0004). The contents are solely the responsibility of the authors and do not necessarily represent the views of the Department of Health and Human Services, NIMH, or the Department of the Army, or the Department of Defense.

Notes on contributors

Robert J. Ursano

Robert J. Ursano, MD, James A. Naifeh, PhD, Oscar I. Gonzalez, PhD, Carol S. Fullerton, PhD, Holly Herberman Mash, PhD, Charlotte A. Riggs-Donovan, MS, Tsz Hin Hinz Ng, MPH, LTC Gary H. Wynn, MD, and Hieu M. Dinh, BS, are affiliated with the Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, in Bethesda, Maryland. Tzu-Cheg Kao, PhD, is affiliated with the Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, in Bethesda, Maryland. Ronald C. Kessler, PhD, and Nancy A. Sampson, BA, are affiliated with the Department of Health Care Policy, Harvard Medical School, in Boston, Massachusetts. Steven G. Heeringa, PhD, is affiliated with the Institute for Social Research, University of Michigan, in Ann Arbor, Michigan. Murray B. Stein, MD, MPH, is affiliated with the Department of Psychiatry and the Department of Family and Preventive Medicine, University of California San Diego, in La Jolla, California; and the VA San Diego Healthcare System, in La Jolla, California.