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- Title
Factors Associated With Suicide Ideation in US Army Soldiers During Deployment in Afghanistan.
- Authors
Ursano, Robert J.; Herberman Mash, Holly B.; Kessler, Ronald C.; Naifeh, James A.; Fullerton, Carol S.; Aliaga, Pablo A.; Stokes, Cara M.; Wynn, Gary H.; Ng, Tsz Hin Hinz; Dinh, Hieu M.; Gonzalez, Oscar I.; Zaslavsky, Alan M.; Sampson, Nancy A.; Kao, Tzu-Cheg; Heeringa, Steven G.; Nock, Matthew K.; Stein, Murray B.
- Abstract
Key Points: Question: What factors are associated with 30-day suicide ideation among US Army soldiers at the midpoint of their deployment in Afghanistan? Findings: This survey study of 3957 soldiers who completed self-administered questionnaires at middeployment found an estimated prevalence of lifetime, past-year, and 30-day suicide ideation of 11.7%, 3.0%, and 1.9%, respectively. Risk factors associated with 30-day suicide ideation included white race/ethnicity, lifetime noncombat trauma exposure, and past 30-day and lifetime major depressive disorder. Meaning: These findings suggest that research examining deployment experiences that increase suicide ideation in soldiers with past trauma and major depressive disorder may assist clinicians and leadership in identifying and treating those at increased risk. This survey study examines the association of sociodemographic characteristics, lifetime and past-year stressors, and mental disorders with 30-day suicide ideation among US Army soldiers during their deployment in Afghanistan. Importance: Understanding suicide ideation (SI) during combat deployment can inform prevention and treatment during and after deployment. Objective: To examine associations of sociodemographic characteristics, lifetime and past-year stressors, and mental disorders with 30-day SI among a representative sample of US Army soldiers deployed in Afghanistan. Design, Setting, and Participants: In this survey study, soldiers deployed to Afghanistan completed self-administered questionnaires in July 2012. The sample was weighted to represent all 87 032 soldiers serving in Afghanistan. Prevalence of lifetime, past-year, and 30-day SI and mental disorders was determined. Logistic regression analyses examined risk factors associated with SI. Data analyses for this study were conducted between August 2018 and August 2019. Main Outcomes and Measures: Suicide ideation, lifetime and 12-month stressors, and mental disorders were assessed with questionnaires. Administrative records identified sociodemographic characteristics and suicide attempts. Results: A total of 3957 soldiers (3473 [weighted 87.5%] male; 2135 [weighted 52.6%] aged ≤29 years) completed self-administered questionnaires during their deployment in Afghanistan. Lifetime, past-year, and 30-day SI prevalence estimates were 11.7%, 3.0%, and 1.9%, respectively. Among soldiers with SI, 44.2% had major depressive disorder (MDD) and 19.3% had posttraumatic stress disorder in the past 30-day period. A series of analyses of the 23 grouped variables potentially associated with SI resulted in a final model of sex; race/ethnicity; lifetime noncombat trauma; past 12-month relationship problems, legal problems, and death or illness of a friend or family member; and MDD. In this final multivariable model, white race/ethnicity (odds ratio [OR], 3.1 [95% CI, 1.8-5.1]), lifetime noncombat trauma (OR, 2.1 [95% CI, 1.1-4.0]), and MDD (past 30 days: OR, 31.8 [95% CI, 15.0-67.7]; before past 30 days: OR, 4.9 [95% CI, 2.5-9.6]) were associated with SI. Among the 85 soldiers with past 30-day SI, from survey administration through 12 months after returning from deployment, 6% (5 participants) had a documented suicide attempt vs 0.14% (6 participants) of the 3872 soldiers without SI. Conclusions and Relevance: This study suggests that major depressive disorder and noncombat trauma are important factors in identifying SI risk during combat deployment.
- Subjects
AFGHANISTAN; UNITED States; CONFIDENCE intervals; DEPLOYMENT (Military strategy); MENTAL depression; ETHNIC groups; FACTOR analysis; MENTAL illness; POST-traumatic stress disorder; EMOTIONAL trauma; QUESTIONNAIRES; RACE; RESEARCH funding; PSYCHOLOGY of military personnel; PSYCHOLOGICAL stress; SUICIDAL behavior; SURVEYS; LOGISTIC regression analysis; SOCIOECONOMIC factors; SUICIDAL ideation; DISEASE prevalence; DATA analysis software; DESCRIPTIVE statistics; ODDS ratio
- Publication
JAMA Network Open, 2020, Vol 3, Issue 1, pe1919935
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2019.19935