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Study: Mental health woes, not deployment or combat, raise military suicide risk

Military suicide rates have increased sharply in recent years, drawing the attention of government officials and mental health experts looking for ways to reverse the trend.


Researchers looking at risk factors for why military members may take their own lives have found that having a prior mental health disorder or being a male increased suicide risk. Where the solider was deployed or whether the person was in combat, however, were not associated with raised risk.

"Beginning in 2005, the incidence of suicide deaths in the U.S. military began to sharply increase," wrote the study's authors, led by Cynthia A. LeardMann, a biostatistician at the Naval Health Research Center in San Diego. "Unique stressors, such as combat deployments, have been assumed to underlie the increasing incidence."

But, "The findings from this study do not support an association between deployment or combat with suicide, rather they are consistent with previous research indicating that mental health problems increase suicide risk," the authors added.

In what they're calling the first prospective study of suicide risk to track military members from all branches, researchers analyzed a pool of more than 151,000 current and former U.S. military personnel who were enrolled in the Millennium Cohort Study. The study tracked servicemembers from 2001 through 2008. Participants were given questionnaires, then researchers looked at the Department of Defense's mortality registry to check who had died.

They identified 83 suicides among the study participants. Based on the data, the researchers associated increased suicide risk with being a male, having depression, manic-depressive (bipolar) disorder, being a heavy or binge drinker and having alcohol-related problems.

Those are risk factors for suicide for anyone -- not just military personnel. That suggests the increased suicide rate in the military may be a product of increased prevalence of mental health disorders nationwide, the authors wrote -- possibly an indirect byproduct of occupational stress when at home or deployed.

"Therefore, knowing the psychiatric history, screening for mental and substance use disorders, and early recognition of associated suicidal behaviors combined with high-quality treatment are likely to provide the best potential for mitigating suicide risk," the researchers concluded in the study, which was published Aug. 6 in JAMA.

A May study in JAMA Psychiatry linked traumatic brain injuries (TBIs) to increased suicide riskamong military personnel. The new study did not look at incidence rates of TBIs.

Researchers also found in a May issue of Pediatrics that children of military servicemembers may be at an increased risk for social, emotional and behavioral problems.

In an accompanying editorial published in the same journal issue, Dr. Charles C. Engel, an associate professor of psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Md., writes that because the study ended in 2008, "some may misinterpret the findings as evidence that 12 years of war is not to blame for the recent increase in military suicide rates."

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He also points out the study did not compare civilian and military populations. But, the findings suggest some of the major risks of military suicide could be prevented with evidence-based treatments, he said.

"These findings offer some potentially reassuring ways forward: the major modifiable mental health antecedents of military suicide -- mood disorders and alcohol misuse -- are mental disorders for which effective treatments exist," wrote Engel.  Such success will also require addressing long-standing military ambivalence toward the medical model of mental illness -- an ambivalence affecting service members, military clinicians, and senior leaders alike."

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