Mash HBH, et al. Am J Psychiatry. 2021;doi:10.1176/appi.ajp.2021.20111570.

Disclosures: Mash reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
September 16, 2021
3 min read

Attempted suicide high among some soldiers soon after ideation diagnosis


Mash HBH, et al. Am J Psychiatry. 2021;doi:10.1176/appi.ajp.2021.20111570.

Disclosures: Mash reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Suicide risk was highest in the first 30 days after ideation diagnosis among certain United States Army soldiers, such as women and combat medics, according to findings published in the American Journal of Psychiatry.

Previous studies have explored suicidal tendencies in U.S. Army soldiers, but none have analyzed soldiers with documented suicidal ideation and risk for attempted suicide with the goal of understanding the progression from ideation to attempt.

Holly B. Herberman Mash, PhD
Holly B. Herberman Mash

“A primary focus of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS/STARRS-LS [Longitudinal Study]) is to identify risk factors for suicidal behaviors in order to provide actionable recommendations to the U.S. Army,” Holly B. Herberman Mash, PhD, associate professor in the department of psychiatry at the Uniformed Services University of the Health Sciences in Maryland, told Healio Psychiatry. “The particular problem for clinicians is often, after one makes a diagnosis of suicidal ideation, [determining] who is at greatest risk in order to best use interventions.

“The goal of the current study was to identify specific factors that may increase this imminent risk among those with suicidal ideation, which can be targeted in interventions by clinicians and leadership,” Mash added.

Mash and colleagues used administrative data from the Army STARRS to observe 11,178 active-duty Regular Army enlisted soldiers between 2006 and 2009 (81.7% men; 84.8% aged 29 years or younger; 71.7% white; 65.7% high school educated; 52.7% never married; 64.1% aged younger than 21 years when first entering the Army). All of the soldiers had medically documented suicidal ideation and no prior medically documented suicidal attempts.

Using logistic regression analyses, researchers identified risk factors for suicide attempt within 30 days of first suicidal ideation. Specifically, researchers looked at sociodemographic and service-related characteristics, psychiatric diagnoses, physical health care visits, injuries and history of family violence or crime perpetration or victimization.

Following the first documented suicidal ideation, 830 soldiers attempted suicide, of whom 387 attempted within the first 30 days. Multivariate analyses revealed women (OR = 1.3; 95% CI, 1-1.8), combat medics (OR =1.6; 95%CI, 1.1-2.2), individuals with an anxiety disorder diagnosis prior to suicidal ideation (OR = 1.3; 95% CI, 1-1.6) and soldiers who received a sleep disorder diagnosis on the same day as the recorded suicidal ideation (OR =2.3;95% CI, 1.1-4.6) had increased risk for attempted suicide within 30 days.

In comparison, Black soldiers (OR = 0.6; 95% CI,0.4-0.9) and soldiers who received an anxiety disorder on the same day as suicidal ideation (OR = 0.7; 95% CI, 0.5-0.9) were less likely to attempt suicide within 30 days.

Researchers noted that neither PTSD nor depression diagnoses were linked to increased risk for suicide attempt in those with ideation.

Robert J. Ursano

“The most important part of this paper is that it addresses the often-difficult task of the clinician once a patient is diagnosed with suicide ideation: Who should I worry about the most?” Robert J. Ursano, MD, professor of psychiatry and neuroscience at the Uniformed Services University, told Healio Psychiatry. “The fact that among soldiers with a first diagnosis of suicide ideation who will attempt suicide (about 7%) half will do so within 30 days, emphasizes the importance of targeted and intensive work with those at highest risk during this 30-day period. The findings also highlighted that sleep disorders present at the time of a diagnosis of suicide ideation is one element that can indicate increased need for intervention and follow-up over the following 30 days.”.

According to Ursano, certain factors, such as current sleep disorders, can identify which Army soldiers who are experiencing suicidal ideation may be at imminent risk for a suicide attempt.

“This provides a valuable opportunity for clinicians to address this particular subset of soldiers who are at elevated risk,” Ursano said.

The researchers suggested that future studies should attempt to understand why these demographic and service-related characteristics act as risk or “protective factors” and to try to define various life events that could lead to soldiers’ quick transition to suicide attempt after ideation.

Since this study utilized administrative records, data are subject to classification and coding errors that could skew results. Another limitation of this study is the possibility of labeling self-inflicted injuries as other kinds of injuries.