James Donaldson on Mental Health – Many Soldiers Who Attempt Suicide Have No Prior Mental Health Diagnosis

Over one-third of a sample of American soldiers who attempted suicide did not have a prior mental health diagnosis, a new study published in JAMA Psychiatry finds. But the risk factors that predict suicide attempts in these soldiers are largely the same as those for soldiers who previously have been diagnosed with a mental health issue.

Dr. Robert J. Ursano, a psychiatrist at the Uniformed Services University of the Health Sciences and lead author of the study, said this points to the importance of broad screening efforts.

“There are those at risk who never come into specialty care,” Ursano told Journalist’s Resource.

This research gets at how to better identify this population.

The study looked at administrative records belonging to a sample of 9,650 enlisted U.S. Army soldiers with a documented suicide attempt occurring between 2004 and 2009. Nearly three-quarters of the sample were male. The researchers looked at the risk factors among these soldiers, comparing the factors involved for those with and without a prior history of mental health concerns.

Veterans as a group are at a higher risk for suicide than civilian adults — 22 percent higher, according to a 2016 report from the U.S. Department of Veterans Affairs. Nationally, across the whole population, suicide rates are increasing, according to statistics issued by the U.S. Centers for Disease Control and Prevention.

In their analysis, the researchers found that the risk factors associated with suicide attempts among soldiers were similar irrespective of past mental health history.

Among soldiers who did and did not have a prior mental health diagnosis, those who attempted suicide were more likely to be female and have less than a high school education (GED or similar program). They also were more likely to have experienced job promotion delays or demotion in the past year. However, these risk factors increased the odds of a suicide attempt significantly more in soldiers without a record of past mental health issues than in those with a documented history.

Other risk factors for both groups included family violence, eight or more outpatient physical health care visits in the past two months, injuries in the past month, and previous combat injuries. (The researchers acknowledge in the study that “our injury variable may have captured injuries that were self-inflicted but unrecognized as such.”)

For both groups, soldiers who had married in the past month had lower odds of attempting suicide than those who were unmarried and those who had been married for four to 12 months.

Soldiers without a documented history of mental health concerns were much more likely to attempt suicide early in their service than those with a documented diagnosis history. Nearly 60 percent of the attempts among soldiers without a history occurred in their first year of service, compared with 20 percent for those with a history.

One risk factor unique to those without a mental health diagnosis history was enlisting at a young age – before age 21.

Ursano said the health care system can use this additional information about risk factors to identify and refer vulnerable individuals. He stressed that many of these individuals do come into contact with primary care providers, mentioning the risk factors of past-month injuries and multiple outpatient visits in the past two months. He suggested interventions that tie primary care and mental health care closer together, such as incorporating mental health screening into primary care.

The authors note a few limitations, including the fact that the records analyzed, did not capture unreported suicide attempts and unreported or undiagnosed mental disorders. They also indicate that these findings might not generalize to other populations.

The project was part of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), the largest mental health study ever conducted among military personnel.