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 "Clusters do occur, and if there is a suicide attempt in an Army
unit there is likely to be another attempt in the unit," said lead
author Dr. Robert Ursano, of the Uniformed Services University of
the Health Sciences in Bethesda, Maryland.
Suicide attempts in the U.S. Army increased dramatically during the
Iraq and Afghanistan wars, and the risk might have been influenced
by events within a soldier's unit, Ursano and colleagues write in
JAMA Psychiatry.
To see if factors within a unit predict the risk of future suicide
attempts, the researchers analyzed data from soldiers on active duty
from 2004 through 2009.
They identified 9,512 soldiers who attempted suicide during that
time. Most were men, under age 29, white, educated, married and had
entered the Army before age 21.
The risk that soldiers would attempt suicide increased with the
number of suicide attempts in the same unit over the past year.
Compared to soldiers in units with no suicide attempts over the
previous year, soldiers in units with a recent suicide attempt were
40 percent more likely to attempt suicide themselves, for example.
In units with five or more suicide attempts during the past year,
the risk of another attempt was more than twice as high as in units
with no attempts during the past year.
The increased risk was seen regardless of whether the soldiers had
combat experience and regardless of the size of the unit. Smaller
units had a greater risk, however.
The study can't say why the risk of suicide attempts in a unit
increases with the number of past suicide attempts.
Ursano told Reuters Health that it could be related to a phenomenon
known as contagion, but it could also be due to stresses on the unit
such as a change in leadership or whether the unit is preparing for
or returning from deployment.
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While the study took place among a relatively consistent group of
people with jobs, health insurance and a steady income, Ursano said
the findings may be true for civilians, too.
"These days, it should not be forgotten that people live in groups,
communities and families," he said.
The Israeli Defense Force tackled the issue of suicide attempts by
making sure there was a culture of help-seeking, said Dr. John Mann,
of the Columbia University Medical Center and the New York State
Psychiatric Institute in New York City.
"We have seen in militaries - like the Israeli Defense Force - a
substantial decrease in suicide rates," said Mann, who was not
involved in the new study. "We’ve seen that at a time when the
suicide rates went up in the U.S. military. We can try to learn from
other places about things that affect suicide rates."
People should encourage those at risk to seek help, he said.
Ursano said one avenue for future research is to look at ways to
address the risk of suicide attempts at a group level - instead of
focusing on individuals.
"Think about the stresses on the community the person belongs to as
well as the individual," he said.
SOURCE: http://bit.ly/2uDbJJN and http://bit.ly/2uD47XF JAMA
Psychiatry, online July 26, 2017.
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