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Original Investigation |

Predictors of Suicide and Accident Death in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS):  Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

Michael Schoenbaum, PhD1; Ronald C. Kessler, PhD2; Stephen E. Gilman, ScD3,4; Lisa J. Colpe, PhD, MPH1; Steven G. Heeringa, PhD5; Murray B. Stein, MD, MPH6,7,8; Robert J. Ursano, MD9; Kenneth L. Cox, MD, MPH10 ; for the Army STARRS Collaborators
[+] Author Affiliations
1National Institute of Mental Health, Bethesda, Maryland
2Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
3Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
4Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
5Institute for Social Research, University of Michigan, Ann Arbor
6Department of Psychiatry and Family, University of California, San Diego, La Jolla
7Department of Preventive Medicine, University of California, San Diego, La Jolla
8Veterans Affairs San Diego Healthcare System, San Diego, California
9Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of the Health Sciences, Bethesda, Maryland
10United States Army Public Health Command, Aberdeen Proving Ground, Maryland
JAMA Psychiatry. 2014;71(5):493-503. doi:10.1001/jamapsychiatry.2013.4417.
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Importance  The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multicomponent study designed to generate actionable recommendations to reduce Army suicides and increase knowledge of risk and resilience factors for suicidality.

Objectives  To present data on prevalence, trends, and basic sociodemographic and Army experience correlates of suicides and accident deaths among active duty Regular Army soldiers between January 1, 2004, and December 31, 2009, and thereby establish a foundation for future Army STARRS investigations.

Design, Setting, and Participants  Analysis of trends and predictors of suicide and accident deaths using Army and Department of Defense administrative data systems. Participants were all members of the US Regular Army serving at any time between 2004 and 2009.

Main Outcomes and Measures  Death by suicide or accident during active Army service.

Results  The suicide rate rose between 2004 and 2009 among never deployed and currently and previously deployed Regular Army soldiers. The accident death rate fell sharply among currently deployed soldiers, remained constant among the previously deployed, and trended upward among the never deployed. Increased suicide risk was associated with being a man (or a woman during deployment), white race/ethnicity, junior enlisted rank, recent demotion, and current or previous deployment. Sociodemographic and Army experience predictors were generally similar for suicides and accident deaths. Time trends in these predictors and in the Army’s increased use of accession waivers (which relaxed some qualifications for new soldiers) do not explain the rise in Army suicides.

Conclusions and Relevance  Predictors of Army suicides were largely similar to those reported elsewhere for civilians, although some predictors distinct to Army service emerged that deserve more in-depth analysis. The existence of a time trend in suicide risk among never-deployed soldiers argues indirectly against the view that exposure to combat-related trauma is the exclusive cause of the increase in Army suicides.

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Figure 1.
Suicide Deaths per 100 000 Person-Years of Active Duty Army Service

Shown are Regular Army 12-month moving averages. Each line represents a 12-month moving average (ie, each respective dot reports the rate for the prior 12-month period).

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Figure 2.
Accident Deaths per 100 000 Person-Years of Active Duty Army Service

Shown are Regular Army 12-month moving averages. Each line represents a 12-month moving average (ie, each respective dot reports the rate for the prior 12-month period).

Graphic Jump Location

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