A unit history of suicide attempts increases suicide risk for troops

Smaller military units, combat arms units at greater risk for suicide

By Sharon Holland

Does a previous suicide attempt in a soldier’s unit increase the risk of additional suicide attempts? According to a study published by Uniformed Services University researchers, the answer is yes.

The team, led by Dr. Robert J. Ursano, professor of Psychiatry and Neuroscience and director of USU’s Center for the Study of Traumatic Stress, found that the odds of attempting suicide increased for Soldiers in units where there had been one or more suicide attempts during the past year. The greater the number of previous suicide attempts in the unit, the greater the individual risk for other Soldiers in the unit. The risk was somewhat higher in combat arms units and in smaller units with one to 40 Soldiers.

Using data from the Army Study to Assess Risk and Resilience in Service members (Army STARRS), the scientists looked at historical administrative information from 38 different Army and Department of Defense data systems for more than 1.6 million Soldiers (regular Army, Army Reserve, and National Guard) on active duty from 2004 to 2009. They identified 9,650 suicide attempters among regular Army Soldiers, excluding National Guard and Reserve, during that period.

Army STARRS is the largest study of mental health risk and resilience ever conducted among U.S. Army personnel. Previous research has primarily focused on how Soldiers respond to a suicide death. It is estimated that for every suicide, six to 10 people are profoundly affected and may be at risk for suicidal behaviors.

This new study, published in JAMA Psychiatry July 26, 2017, is important because it looks at Army suicide attempts, which are approximately 10 to 20 times more common than suicides. Contrary to other studies, unit deaths of any type, including suicide, were not significantly associated with the risk of suicide attempt in this study.

“Unit characteristics, including leadership style and quality, extent of social support, group cohesion, and presence of bullying or hazing, may influence unit culture and affect the likelihood of suicide attempts in the unit. Such effects may be more influential in smaller units where the positive or negative factors are more easily experienced by and likely to impact the entire group,” said Ursano, study lead author and Army STARRS co-Principal Investigator. “For example, strong unit cohesion has been associated with reduced distress, increased resilience, and positive states of mind. To the extent that suicide attempts among fellow Soldiers disrupt one’s sense of unit cohesion, these findings suggest that the negative effects may be strongest in smaller units.”

Paying careful attention to unit characteristics by Army leadership and military health care providers may be a component in suicide attempt reduction efforts. Early unit-based postvention, consisting of coordinated efforts to provide behavioral health, psychosocial, spiritual, and public health support following suicide attempts, may be an essential tool in promoting recovery and suicide prevention in Soldiers.