Predicting U.S. Army suicides after hospital discharge

November 12, 2014

Science Daily/Harvard Medical School

Some Army suicides can be predicted with enough accuracy to justify implementing preventive interventions in patients at high risk, experts say. The study looked at 53,769 regular Army soldiers during the 12-month period following their discharge from a psychiatric facility during 2004 to 2009. Hundreds of potential predictors of post-hospital suicide were abstracted from the extensive Army and Department of Defense administrative files that contain data on all soldiers.

"The high concentration of suicide risk in the 5 percent of highest-risk hospitalizations is striking," said lead author Ronald Kessler, McNeil Family Professor of Health Care Policy at Harvard Medical School. "The fact that nearly half of all highest-risk hospitalizations were followed by at least one adverse outcome -- either suicide, unintentional injury death, suicide attempt or rehospitalization -- argues strongly for developing expanded post-hospital preventive intervention services for these highest-risk soldiers."

http://www.sciencedaily.com/releases/2014/11/141112203216.htm

Soldiers at increased risk for suicide within a year of psychiatric in-patient treatment

November 12, 2014

Uniformed Services University of the Health Sciences (USU)

Soldiers hospitalized with a psychiatric disorder have a significantly elevated risk for suicide in the year following hospital discharge, according to research. Although this has long been known in the civilian sector, it has never before been studied in the military population.

The study used data from the Army Study to Assess Risk and Resilience in Service members (Army STARRS), the largest study of mental health risk and resilience ever conducted among U.S. Army personnel. Robert J. Ursano, MD, chair of the Department of Psychiatry at the Uniformed Services University, Murray B. Stein, MD, MPH, professor of Psychiatry and Family and Preventive Medicine at the University of California, San Diego, both co-principal investigators for Army STARRS, and a team of Army STARRS researchers looked at data from the 12 months following a hospital discharge for more than 40,000 regular Army soldiers (excluding National Guard and Reserve) who served on active duty from 2004 through 2009.

The Army's suicide rate began increasing in 2004, exceeded the rate among U.S. civilians (adjusted to match the sex and age distribution of the Army), in 2009, and has remained high through 2014. This study of administrative data shows that 40,820 soldiers (0.8% of all regular Army soldiers who served from 2004-2009) were hospitalized with a psychiatric disorder. Suicides occurring in this group during the year after a hospital discharge accounted for 12% of all Army suicides during this period.

Researchers also found that it was possible to identify smaller, higher-risk groups within this at-risk population. Analyzing soldiers' characteristics and experiences prior to and during hospitalization, researchers identified the 5% of soldiers with the highest predicted risk of suicide after leaving the hospital. This top 5% accounted for 52.9% of the post-hospital suicides. Soldiers in this top 5% also accounted for a greater proportion of accident deaths, suicide attempts, and re-hospitalizations, compared to other previously hospitalized soldiers.

http://www.sciencedaily.com/releases/2014/11/141112161040.htm

Soldiers who kill in combat less likely to abuse alcohol

- June 10, 2014

Science Daily/American University

New research documents the impact of combat experiences on alcohol use and misuse among National Guard soldiers. Whereas much research regarding combat personnel is based on post-experience data, this study's design uses both pre- and post-deployment data to identify the association between different types of combat experiences and changes in substance use and misuse.

It's no secret that combat experiences are highly stressful and can contribute to instances of post-traumatic stress disorder and depression among soldiers post-deployment. It also comes as no surprise that many soldiers afflicted with these conditions abuse alcohol in an attempt to self-medicate.

But new research coauthored by Cristel Russell, an associate professor of marketing with American University's Kogod School of Business, and researchers with the Walter Reed Army Institute of Research finds that the most traumatic of all combat experiences, killing, is less likely to lead to alcohol abuse.

The study, titled "Changes in Alcohol Use after Traumatic Experiences: The Impact of Combat on Army National Guardsmen" and published in the June issue of the journal Drug and Alcohol Dependence, runs contrary to previous research.

"We were very surprised by the findings. Most previous research supported the prediction that more traumatic experiences would lead to more negative health outcomes, such as alcohol abuse," said Russell. "We found the opposite -- that the most traumatic experiences of killing in combat actually led to a decrease in alcohol abuse post-deployment."

Mortality Salience

Why would killing in combat, thought to be one of the most difficult stressors, cause soldiers to become less likely to abuse alcohol? Russell and her colleagues believe that killing experiences may cause soldiers to have an increased sense of mortality and vulnerability that triggers a focus on self-preservation, which manifests itself in reduced high-risk alcohol consumption.

"We reason that a possible explanation may be that soldiers who experience killing during combat become more aware of their own vulnerability to death. Mortality salience is known to have effects on decisions that people make including, in our case, the decision to not take risks and abuse alcohol, presumably to live longer," said Russell. "This is a post hoc explanation and our future research is going to try and explore this intriguing explanation further."

Comparing Pre-and-Post Deployment Data

The study is also one of the first to compare pre-and post- deployment data. Russell and her colleagues used this approach to better identify the associations between different types of combat experiences and changes in alcohol consumption.

For the study, Russell and her fellow researchers surveyed 1,397 members of an Army National Guard Infantry Brigade Combat Team three months before and three months after their deployment to Iraq in 2005-2006. Members of the unit completed anonymous surveys regarding behavioral health and alcohol use and, in the post-survey, the combat experiences they had during deployment.

Aside from the stunning revelation that soldiers who kill in combat are less likely to abuse alcohol post-deployment, survey results revealed that the prevalence of alcohol use increased from 70.8% pre-deployment to 80.5% post-deployment and that alcohol misuse more than doubled, increasing from 8.51% before deployment to 19.15% after deployment.

Next Steps

This study acknowledges that future research is needed on this complex topic. Russell and her colleagues plan to explore the influence mortality salience has on soldiers who have killed while in combat in further detail.

"It is important for healthcare providers and researchers to better understand and account for the fact that traumatic events do not necessarily result in a negative outcome and that positive outcomes can in fact be born from traumatic events," said Russell. "Building on these findings, future research should take into account the degree to which individuals are equipped to deal with stressful situations and assess how coping strategies may affect their behavioral response to potentially traumatic events. There may be ways to promote coping pre- or post-traumatic experiences."

http://www.sciencedaily.com/releases/2014/06/140610122010.htm