Soldiers at High Suicide Risk in Month After Ideation Diagnosis

For soldiers in the U.S. Army, the risk of suicide attempt was highest in the first 30 days after being diagnosed with suicidal ideation, a recent study found.

Among over 11,000 soldiers with medically documented suicidal ideation, 830 (7.4%) attempted suicide, with 46.3% of those attempts coming within 30 days of their diagnosis (rate 35.4 per 1,000 soldiers), reported Robert Ursano, MD, of the Uniformed Services University of the Health Sciences in Bethesda, Maryland, and colleagues.

“Army studies using survey data suggest that the transition from ideation to attempt is often rapid, with the majority of suicide attempts occurring within 1 year,” the team wrote in the American Journal of Psychiatry. “However, this transition time has not been examined using information within the health care system where all soldiers receive care.”

According to multivariate analyses — which took into account sociodemographic factors and service-related characteristics — those more likely to attempt suicide in the 30 days after suicidal ideation diagnosis were soldiers under the age of 21 (OR 1.8, 95% CI 1.1-2.9) and those with 1-2 years of service (OR 1.4, 95% CI 1.0-1.8).

On the other hand, Black soldiers with suicidal ideation were less likely to attempt suicide in the 30 days after their diagnoses (OR 0.6, 95% CI 0.4-0.9).

“Although these differences are not well understood, some researchers have suggested that they may reflect the protective role of cultural and family ties and spiritual/religion-based coping strategies,” Ursano and colleagues wrote, adding that more research is needed “to understand why these demographic and service-related characteristics act as risk or protective factors.”

Ursano and team used data from the Army Study to Assess Risk and Resilience in Servicemembers and identified 11,178 active-duty Army soldiers from 2006 to 2009 who had medically documented suicidal ideation, with no prior records of a suicide attempt.

Soldiers with documented suicidal ideation were primarily:

• Men (81.7%)
• White (71.7%)
• Ages 29 and younger (84.8%)
• High school educated (65.7%)
• Never married (52.7%)
• Younger than 21 when they first enlisted (64.1%)
• In their first 2 years of service (52.7%)
• Had never deployed (57.7%)
• Assigned to combat arms (27.3%)

The authors found that the risk of a suicide attempt following an ideation diagnosis was more likely among women (OR 1.3, 95% CI 1.0-1.8), combat medics (OR 1.6, 95% CI 1.1-2.2), those diagnosed with an anxiety disorder before their ideation diagnosis (OR 1.3, 95% CI 1.0-1.6), and those who received a same-day sleep disorder diagnosis (OR 2.3, 95% CI 1.1-4.6).

Many of these findings fall in line with past research, which also found that female soldiers and combat medics are at an elevated risk of suicide attempt. However, while a history of an anxiety disorder was associated with a higher likelihood of a suicide attempt in the days after receiving a diagnosis for suicidal ideation, a same-day anxiety disorder diagnosis was associated with a decreased risk — a finding the authors described as “unexpected.”

“One possible explanation might be that an anxiety disorder diagnosis on the same day as ideation may have led clinicians to a rapid intervention (e.g., psychiatric treatment and/or prescription of an anxiolytic), mitigating risk of attempt,” the authors proposed.

Notably, neither post-traumatic stress disorder (PTSD) nor depression-related diagnoses were found to be associated with an increased risk of 30-day suicide attempt among those with suicidal ideation, despite the commonality of depression-related diagnoses among this population. This, the researchers concluded, suggested that the presence of these disorders may influence the presence of ideation, but does not necessarily predict the likelihood of a suicide attempt in the 30 days after a diagnosis.

That the findings were based on data extracted from administrative records remains one of the study’s major limitations, the team acknowledged. The cases, therefore, may have been subject to “classification and coding errors and are limited to the events that come to the Army’s attention,” they wrote.

Additionally, because the study focused solely on 2006-2009, the results may not be generalizable to other time periods. The time period at hand, though, is a crucial case study, as the suicide rate among U.S. Army soldiers during the wars in Iraq and Afghanistan surpassed the civilian suicide rate in 2008, and reached a peak in 2012.

If you or someone you know is considering suicide, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).