CHICAGO -- War-time suicide attempts in the U.S. Army are most common in newer enlisted soldiers who have not been deployed, while officers are less likely to try to end their lives. At both levels, attempts are more common among women and those without a high school diploma, according to a study billed as the most comprehensive analysis of a problem that has plagued the U.S. military in recent years.
Suicides in the military have gotten the most attention, but attempts are more prevalent and sometimes have different contributing factors. They're "an opportunity to intervene," said Dr. Robert Ursano, psychiatry chairman at the Uniformed Services University and the study's lead author.
The study analyzed records on nearly 10,000 suicide attempts among almost 1 million active-duty Army members during the wars in Afghanistan and Iraq, from 2004 to 2009. That compares with 569 Army suicide deaths during the same period reported by researchers last year in a different phase of the same study. Rates for both increased during that time.
The new research was published Wednesday in the journal JAMA Psychiatry. Some key points:
ATTEMPTS VS DEATHS
Suicide attempts and deaths were more common among enlisted soldiers than officers. The new research found an attempt rate of 377 per 100,000 among enlisted soldiers versus almost 28 per 100,000 among officers. Attempts and suicide deaths were more common among whites than blacks and Hispanics; among those with no college education; and those at early stages of their Army careers. Recent diagnosis of mental illness was another common characteristic.
Compared with Army men, attempts were more common in women but deaths were less common. Attempts were more common but deaths were less common in soldiers who weren't deployed versus the currently deployed.
"Suicide attempts and completed suicides have different predictors in most studies," said Ursano. "They may in fact represent different 'disorders'" related to suicide.
WHAT ABOUT CIVILIANS?
Comparing military suicide attempt rates with civilian rates is difficult because of differences in methods used, Ursano said. The study cites nonfatal self-injury rates for U.S. men aged 18 to 34 during the same time -- about 214 per 100,000 and slightly higher rates for women, but these only involve injuries treated in hospital emergency rooms and may include self-injuries that weren't suicide attempts.
In recent years, Army suicide rates have surpassed civilian rates although military estimates are generally lower than others.
The new results will help the Army identify which prevention programs are most beneficial, Ursano said.
Suicide attempts can lead to a medical discharge but they are not grounds for automatic dismissal, according an Army spokeswoman.
Early-career soldiers may be particularly vulnerable because of trouble adjusting to military life and anxiety over potentially being deployed to combat, said psychologist Craig Bryan, associate director of the National Center for Veterans Studies at the University of Utah.
An atmosphere that encourages mental toughness may discourage some suicidal soldiers from seeking help, said Bryan, whose research found promising results with an intervention that uses military-sounding names for traditional behavior therapy methods. For example, dubbing the "hope box" method of focusing on positive thoughts a "survival kit," and calling special relaxation techniques "tactical breathing" made them more appealing to soldiers.'
"It didn't seem like silly stuff to them anymore," he said.