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 "It was certainly intuitive as the wars went on and suicides went up
for people to assume that deployment was the reason, but our data
show that that is too simplistic; when you look at the total
population, deployment is not associated with suicide," said lead
author Mark Reger, of Joint Base Lewis-McChord in Tacoma,
Washington.
While the U.S. military has traditionally experienced lower suicide
rates than the civilian population, suicides among active duty
service members have surged in the past decade, almost doubling in
the Army and the Marines Corps, Reger said.
To understand the link between deployment and suicide, Reger and
colleagues analyzed military records for more than 3.9 million
service members in active or reserve duty in support of the
conflicts in Iraq and Afghanistan at any point from October 7, 2001
to December 31, 2007.
A total of 31,962 deaths occurred, including 5,041 suicides, by
December 31, 2009.
Suicide rates were similar regardless of deployment status. There
were 1,162 suicides among those who deployed and 3,879 among those
who didn't, representing suicide rates per 100,000 person-years of
18.86 and 17.78, respectively.
Leaving the military significantly increased suicide risk, however,
with a suicide rate of 26.06 after separating from service compared
with 15.12 for those who remained in uniform. Those who left sooner
had a greater risk, with a rate of 48.04 among those who spent less
than a year in the military.
Service members with a dishonorable discharge were about twice as
likely to commit suicide as those who had an honorable separation.
"This is the first time such a huge, comprehensive study has found
an increased suicide risk among those who have separated from
service, particularly if they served for less than four years or had
an other than honorable discharge," said Rajeev Ramchand, a
researcher in military mental health and suicide prevention at Rand
Corporation who wasn't involved in the study.
It's possible that pre-deployment examinations may screen out people
who have mental health problems, making those who deploy several
times a healthier, more resilient group, said Dr. Alan Peterson, a
psychologist at the University of Texas Health Science Center in San
Antonio who specializes in combat-related post traumatic stress
disorder (PTSD).
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"Those who really struggle with a deployment don't go the second
time," said Peterson, a retired military psychologist who wasn't
involved in the study. "Early separation from the military is often
a marker for something else."
For those contemplating suicide, access to firearms can exacerbate
the problem, Peterson said. "It's a risk factor that sometimes gets
overlooked, but we've seen when they don't have access to weapons
they are less likely to kill themselves."
Some service members who leave the military early may have had risk
factors for suicide such as mood disorders or substance abuse
problems that contributed to their separation, particularly if they
had a dishonorable discharge, said Dr. Christine Moutier, chief
medical officer of the American Foundation for Suicide Prevention.
"Some of the dishonorable discharges may be related to having a
mental health disorder and being unable to keep that behavior in
check and breaking the rules, and some of the early separations may
be people in distress who appropriately opted out of service," said
Moutier, who wasn't involved in the study.
It isn't realistic to expect former service members to instantly
reintegrate into their former civilian lives, but they may be
experiencing serious mental health problems if they're not eating or
sleeping or if they're extremely agitated or irritable, Moutier
said.
"The lack of an association between deployment and suicide risk
isn't surprising," she said. "At a very high level, these findings
highlight the need for us to pay closer attention to what happens
when people leave the military."
SOURCE: http://bit.ly/1BMzKsh
JAMA Psychiatry, online April 1, 2015.
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