Time-varying associations of suicide with deployments, mental health conditions, and stressful life events among current and former US military personnel
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Authors
Shen, Yu-Chu
Cunha, Jesse M.
Williams, Thomas V.
Subjects
Advisors
Date of Issue
2016
Date
Publisher
Language
Abstract
Background
U.S. military suicides have increased significantly over the past decade and currently account for
almost 20% of all military deaths. We investigated the associations of a comprehensive set of
time-varying risk factors with suicides among current and former service members.
Methods
Retrospective multivariate analysis of all U.S. military personnel between 2001-2011
(N=110,035,573 person-quarters, representing 3,795,823 service members). Outcome was death
by suicide, either during service or post-separation. Cox proportional hazard models at the
person-quarter level were used to examine associations of deployment, mental disorders, history
of unlawful activity, stressful life events, and other demographic and service factors with suicide
death.
Findings
The strongest predictors of suicide were current and past diagnoses of self-inflicted injuries,
major depression, bipolar disorder, substance use disorder, and other mental health conditions
(comparing to those with no history of diagnoses, hazard ratio, HR, ranged from 1.4 [CI, 1.14-
1.72] to 8.34 [CI, 6.71-10.37]). Compared to those never deployed, hazards were lower among the
currently-deployed (HR=0.50; CI,0.40-0.61) but significantly higher in the quarters following first
deployment (HR=1.51; CI, 1.17-1.96). Hazard of suicide was elevated within the first year of
separation from the military (HR=2.49; CI,2.12-2.91), and remained high for those who separated 6
or more years ago (HR=1.63; CI,1.45-1.82).
Interpretation
Elevated hazard of suicide death varies by time-since-exposure to deployment, mental health
diagnoses, and other stressful life events. Continued monitoring is particularly needed for these
high-risk individuals. Additional information should be gathered to address the persistent elevated
risks of suicides among service members after separation.
Type
Article
Description
This abbreviated version provided by author request.
The article of record as published may be found at http://dx.doi.org/10.1016/S2215-0366(16)30304-2
The article of record as published may be found at http://dx.doi.org/10.1016/S2215-0366(16)30304-2
Series/Report No
Department
Business & Public Policy (GSBPP)
Organization
Naval Postgraduate School (U.S.)
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NPS Report Number
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Format
26 p.
Citation
Shen, Y., Cunha J., and Williams, T.V. 2016. Time-varying associations of suicide with deployments,
mental health conditions, and stressful life events among current and former US military personnel:
a retrospective multivariate analysis. Lancet Psychiatry 3 (11): 1039-1048.
Distribution Statement
Rights
This publication is a work of the U.S. Government as defined in Title 17, United States Code, Section 101. Copyright protection is not available for this work in the United States.