Combat deployments, no matter how many or how long, were not the reason for the notable increase in military suicides, according to a study of current and former U.S. servicemembers from 2001 to 2008.
The study, published in the Journal of the American Medical Association, found that military members’ risk of suicide was associated with the same factors as those in the civilian population: being male, and suffering from depression and alcohol or drug abuse.
The study by Cynthia A. LeardMann, M.P.H., of the Naval Health Research Center, San Diego, and colleagues, comes eight years after the military suicide rate began climbing as the military fought two wars.
The findings of the study -- thought to be the first that in addition to tracking active-duty troops, followed servicemembers after they resumed civilian life -- counter the conventional wisdom that combat stress, number of deployments and the operations tempo as the U.S. fought wars in Iraq and Afghanistan had caused more troops to take their own lives.
“In this sample of current and former military personnel … suicide risk was independently associated with male sex and mental disorders but not with military-specific variables,” the study, “Risk Factors Associated with Suicide in Current and Former U.S. Military Personnel,” said.
The study looked at deaths of troops among the 151,597 participating in the military’s Millennium Cohort Study, a health study in which participants complete surveys every three years. Researchers then linked that data with the National Death Index and the Department of Defense Medical Mortality Registry through December 31, 2008.
Between 2001 and 2008, there were 83 suicides -- 12.8 percent -- among a total of 646 deaths of those enrolled in the Millennium Cohort Study.
“In models adjusted for age and sex, factors significantly associated with increased risk of suicide included male sex, depression, manic-depressive disorder, heavy or binge drinking, and alcohol-related problems,” the study said. “The authors found that none of the deployment-related factors (combat experience, cumulative days deployed, or number of deployments) were associated with increased suicide risk in any of the models.”
The study noted that other studies have shown a marked increase in the incidence of mental health disorder diagnoses among active-duty servicemembers since 2005, paralleling the suicide incidence.
“This suggests that the increased rate of suicide in the military may largely be a product of an increased prevalence of mental disorders in this population …,” the study said.
The study suggested prevention efforts should focus on addressing mental health disorders and substance abuse, even as it noted that “there are limited studies that validate prevention initiatives.”
Similarly, Dr. Charles Engel, a psychiatrist at the Uniformed Services University of Health Sciences in Bethesda, Md., in an editorial on the study also published in JAMA, said the findings offered “potentially reassuring ways forward” because treatment exists for mood disorders and alcohol misuse.
“Collaborative primary care management is a strategy strongly recommended by the National Institute of Mental Health to military senior leaders as perhaps the most promising suicide prevention strategy.”
Engel also wrote that lasting success in treating military mental health disorders that precede suicide will “require addressing the long-standing military ambivalence toward the medical model of mental illness,” which keeps troops from seeking help because receiving a mental-health diagnosis is not confidential, carries a stigma and can impede a career.
“(T)here are no vaccines to prevent mental disorders, and the study findings suggest the need to remain circumspect about the capacity to reduce suicide rates in practice,” Engel wrote.
Notably absent in the study and Engel’s editorial was any mention of suicide methods and reducing access to them, one of the few suicide prevention techniques that has been demonstrated to be effective.
“What’s remarkable to me is they did not mention the role of reducing access to firearms at all,” said Dr. Matthew Miller, the associate director of the Harvard Injury Control Research Center at the Harvard School of Public Health.
“Yes, it’s very important to treat underlying mental illness and substance abuse. But it’s also crucial to recognize that reducing access to firearms, especially in a population of men who’ve served in the military is probably the surest way to reduce the rate of suicide. It should be mentioned on equal footing with recommendations to treat underlying human suffering.”
Most military suicides are committed with firearms, while about half of civilian suicides use firearms, according to studies by the Army and the Centers for Disease Control and Prevention.
The JAMA study’s conclusion buttresses what senior military leaders have suggested since at least 2010 after years of accruing suicide data, particularly in the Army.
In July 2010, an Army report said that 79 percent of active-duty soldiers who committed suicide had deployed only once or not at all; that 60 percent of suicides occurred during a soldier’s first enlistment, most often in the first year; and that among the highest suicide rates were those of men who enlisted in their late 20s.
In 2009, when 310 servicemembers killed themselves, the Army’s suicide rate of 20 per 100,000 soldiers was double what it had been a decade earlier and for the first time surpassed the civilian rate of 19 per 100,000 in a civilian population with similar demographics.
The Army report suggested that the increase was in part attributable to enlisting more at-risk soldiers after recruitment and retention standards were reduced in 2004. More than half of 80,403 waivers granted were to people with a history of drug or alcohol abuse, or crimes, the Army report said, and offenses that once had meant discharge were overlooked.
The U.S. civilian suicide rate also sharply increased from 1999 to 2010, the Centers for Disease Control and Prevention reported this spring, particularly for middle-age men. Their rate was 27.3 deaths per 100,000.
There were 349 suicides by active-duty service members in 2012, according to Pentagon figures, up from 301 the year before.