Is Suicide Attempt Risk Among US Soldiers Connected to Premilitary Mental Health?

Preenlistment mental health factors and knowledge of the time course can be beneficial in identifying suicide attempt (SA) risk in US soldiers with or without a mental health diagnosis, according to findings published in JAMA Network Open.

Researchers found the period of greatest SA risk and baseline risk factors for SA were similar in soldiers regardless of a mental health diagnosis.

Data was extracted from a representative survey of soldiers in the US Army entering basic combat training between April 1, 2011, and November 30, 2012, who were followed up via administrative records for the initial 48 months of service.

Baseline factors included preenlistment lifetime history of mental disorder, suicide ideation, SA, and nonsuicidal self-injury.

The study included 21,722 respondents (86.2% male, 20.4% Black, 61.8% White non-Hispanic), 253 made an SA in the first 48 months of service (male [75.4%]; Black [22.7%], White non-Hispanic [59.9%], or another race or ethnicity [17.4%]).

For both soldiers who did and did not have a mental health diagnosis during service the risk of SA peaked toward the end of the first year of service.

Study results showed 42.3% of respondents reported at least 1 of the 4 baseline risk factors. Of these individuals, 50.2% received an administrative mental health diagnosis vs 41.5% with no diagnosis and 1.6% had a documented suicide attempt vs 1% with none.

Medically documented suicide attempts were associated with mental disorder (OR, 1.4; 95% CI, 1.0-1.9), SA (OR, 3.4; 95% CI, 2.1-5.6), and NSSI (OR, 1.8; 95% CI, 1.1-2.8) among individuals who received a mental health diagnosis.

According to study authors, the only explanatory variable that differed based on history of mental health diagnosis was preenlistment SA (χ²₁ = 4.7; P = .03), which had a larger odds ratio among soldiers with no mental health diagnosis.

“Although the findings of the present study support screening incoming soldiers for mental disorders and self-injurious thoughts and behaviors,” concluded researchers. “Future research should consider dimensions of emotional, behavioral, and interpersonal functioning that are unlikely to be included in typical screening programs but may underlie a broad range of mental health problems." 

Reference:
Naifeh JA, Ursano RJ, Stein MB, et al. Association of premilitary mental health with suicide attempts during US army service. JAMA Netw Open. 2022;5(6):e2214771. doi:10.1001/jamanetworkopen.2022.14771