Researchers say soldiers who joined the Army after age 25 and those who haven’t been deployed yet are at the highest risk for suicide attempt.

Just like in war, U.S. Army soldiers appear to be bearing the brunt of the casualties when it comes to suicide.

Enlisted soldiers who joined the Army at age 25 or older had more than 16 times the risk for a suicide attempt as officers in the same group, according to an article published today by JAMA Psychiatry.

In addition, enlisted female soldiers are nearly 13 times more likely than female officers to attempt suicide.

The findings are based on a new analysis of Army data that also identified risk factors. These include age at enlistment, race and ethnicity, level of education, length of service, deployment status, and undergoing a recent mental health diagnosis.

The results show that while enlisted soldiers constituted 83 percent of active-duty, regular Army soldiers, they accounted for 98 percent of all suicide attempts.

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The study was conducted by Dr. Robert J. Ursano, a professor and chair of the department of psychiatry at the Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, and his research colleagues.

They analyzed data on the experiences of 9,791 active-duty U.S. Army members during the wars in Afghanistan and Iraq who attempted suicide. The data came from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

Ursano, also director of the USUHS Center for the Study of Traumatic Stress, is a leading researcher on post-traumatic stress disorder (PTSD) and suicide in the military.

His research took a comprehensive look at data from 2004 to 2009, when the Army experienced the longest sustained rise in suicide rates relative to other U.S. military services.

“We found that enlisted soldiers had higher odds for a suicide attempt if they were female, had entered the Army at 25 or older, were currently 29 or younger, did not complete high school, were in their first four years of service, and had a mental health diagnosis during the previous month,” Ursano said.

“The risk for enlisted soldiers was highest in the second month of service and declined as the length of service increased,” he added. “Lower odds of a suicide attempt were associated with being of black, Hispanic, or Asian race or ethnicity.”

In addition, currently deployed enlisted soldiers were less likely than other enlisted soldiers to attempt suicide, with higher odds of suicide attempts among never deployed and previously deployed enlisted soldiers.

The study found similar risk factors for officers. Odds of a suicide attempt were higher for officers who were female, entered the Army at 25 or older, and had a mental health diagnosis in the previous month.

Officers who were 40 or older had lower odds of an attempt. Among officers, neither length of service nor deployment status was a factor in suicide attempts.

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The analysis revealed that rates of non-fatal suicide attempts among soldiers rose sharply between 2004 and 2009, on a parallel track with the trend in suicide deaths. However, Ursano and his colleagues concluded that their understanding of Army suicide attempts remains limited.

Psychiatrists do not understand why the women in the study have higher suicide attempt rates than the men, Ursano said. He pointed out, however, that sexual harassment is a substantial stress.

“Interventions to decrease sexual harassment can enable soldiers and others to feel cared for, provide opportunities to help, and change the context of living to one that is supportive of individual growth and achievement,” he said. “The study showed that those who were younger, never deployed, previously deployed, and early in their career were at greatest risk. All of these factors can bring additional stress.”

The authors said their study concentrated only on suicide attempts documented by the Army’s healthcare system. Such records do not include undocumented suicide attempts, or unreported treatment at civilian facilities. In addition, the authors were unable to look at suicide attempts among those individuals who recently had left the Army.

“A suicide attempt is an opportunity to help someone,” Ursano said. “It is an index of stress and needed help. How to best interview for individuals and for populations is an important area for study and for developing new interventions.”

The authors state that future studies should examine suicide attempt risk in the context of other military characteristics, including occupation specialty, number of previous deployments, history of promotion and demotion, and mental health indicators that include number and types of psychiatric diagnoses, as well as treatment history.

In their conclusion, the authors wrote: “Enlisted soldiers in their first tour of duty account for most medically documented suicide attempts. Risk is particularly high among soldiers with a recent mental health diagnosis. A concentration-of-risk strategy that incorporates factors such as sex, rank, age, length of service, deployment status, and mental health diagnosis into targeted prevention programs may have the greatest effect on population health within the U.S. Army.”

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