New research in the American Journal of Psychiatry identifies factors that may help assess suicide risk in soldiers. According to the study, Predictors of Suicide Attempt Within 30 Days After First Medically Documented Suicidal Ideation in U.S. Army Soldiers, suicide risk was highest within 30 days after ideation diagnosis and was more likely among women and combat medics.
“This Suicide Prevention Month, it’s important to remember that research can help us better understand risk factors and which populations are more vulnerable,” said APA President Vivian Pender, M.D. “It is also a reminder that we can all play a role in preventing suicide by learning to recognize signs of distress and reaching out to connect anyone at risk with help.”
The authors examined risk factors for suicide attempt within the first month after a diagnosis of suicidal ideation, looking at sociodemographic and service-related characteristics, psychiatric diagnoses, physical health care visits, injuries, and others. Using data from the Army Study to Assess Risk and Resilience in Servicemembers, the researchers reviewed records from more than 11,000 active duty enlisted soldiers with documented suicidal ideation and no prior documented suicide attempts.
About half (52.7%) of the solders identified with suicide ideation were in their first two years of service and 57.7% had never deployed. About 80% had had at least one outpatient visit in the previous two months. The most common psychiatric diagnoses were depression and related disorders, tobacco use disorder, anxiety disorder and adjustment disorder.
In the study, 7.4% soldiers with suicidal ideation subsequently attempted suicide. Almost half of the attempts, 3.5%, occurred within 30 days after suicidal ideation. The risk for suicide attempt was highest on the first day after suicidal ideation diagnosis and decreased over time.
The study found that females, combat medics, individuals with an anxiety disorder diagnosis prior to suicidal ideation, and those diagnosed with a sleep disorder on the same day as the suicidal ideation were more likely to attempt suicide within 30 days.
"Identifying suicide risk in the population, in patients in primary care, and in patients in psychiatric care who frequently have suicide ideation, are all challenging and different questions,” said Robert J. Ursano, M.D., one of the study authors and Director, Center for the Study of Traumatic Stress, Uniformed Services University. “This paper importantly speaks to psychiatrists and other mental health care providers who have to make difficult treatment and management decisions for those specifically struggling with suicide ideation."
While depression-related diagnoses were common among the soldiers with suicide ideation, they were not associated with an increased risk of suicide attempt during the first month. Major depression was diagnosed in 24% of soldiers with suicide ideation and depression-related diagnoses (such as dysthymic disorder and adjustment disorder with depressed mood) were diagnosed in nearly 60% of soldiers on the same day suicide ideation was diagnosed. A diagnosis of posttraumatic stress disorder was also not associated with an increased risk of suicide attempt within 30 days.
See also two recent articles on suicide risk published in the APA journal Psychiatric Services:
- Suicide Mortality Among Veterans Health Administration Care Recipients With Suicide Risk Record Flags, published online July 29, 2021
- Predicting the Transition From Suicidal Ideation to Suicide Attempt Among Sexual and Gender Minority Youths, published online August 4, 2021
More information is available in curated collections of Psychiatric Services articles on:
- Suicide Prevention, Part 1: Identifying and Predicting Risk, Vulnerable Populations, Public Perceptions, and Priority Settings - October 2020
- Suicide Prevention, Part 2: Evidence-Based Practices, Cost-Effectiveness, and Future Directions - November 2020
American Psychiatric Association
The American Psychiatric Association, founded in 1844, is the oldest medical association in the country. The APA is also the largest psychiatric association in the world with 37,400 physician members specializing in the diagnosis, treatment, prevention and research of mental illnesses. APA’s vision is to ensure access to quality psychiatric diagnosis and treatment. For more information, please visit www.psychiatry.org.
American Journal of Psychiatry
Subject of Research
Predictors of Suicide Attempt Within 30 Days After First Medically Documented Suicidal Ideation in U.S. Army Soldiers
Article Publication Date
Dr. Kessler has received support for epidemiological studies from SanofiAventis; he has served as a consultant for DataStat, Holmusk, Johnson & Johnson Wellness and Prevention, RallyPoint Networks, Sage Pharmaceuticals, Shire, and Takeda and on advisory boards for Johnson & Johnson Services Lake Nona Life Project; and he has stock options in Mirah, PYM, and Roga Sciences. Dr. Stein has received research support from the Department of Defense, the Department of Veterans Affairs, and NIH; he has served as a consultant for Actelion, Acadia Pharmaceuticals, Aptinyx, ATAI Life Sciences, Boehringer Ingelheim, Bionomics, BioXcel Therapeutics, Clexio, EmpowerPharm, Engrail Therapeutics, GW Pharmaceuticals, Janssen, Jazz Pharmaceuticals, and Roche/Genentech and on scientific advisory boards for the Anxiety and Depression Association of America and the Brain and Behavior Research Foundation; he receives remuneration for his editorial work on Depression and Anxiety (Editor-in-Chief), Biological Psychiatry (Deputy Editor), and UpToDate (Co-Editor-in-Chief for Psychiatry); and he has stock options in Epivario and Oxeia Biopharmaceuticals. The other authors report no financial relationships with commercial interests