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Understanding the elevated suicide risk of female soldiers during deployments

Published online by Cambridge University Press:  31 October 2014

A. E. Street ,
S. E. Gilman ,
A. J. Rosellini ,
M. B. Stein ,
E. J. Bromet ,
K. L. Cox ,
L. J. Colpe ,
C. S. Fullerton ,
M. J. Gruber  and
S. G. Heeringa
...Show all authors
A. E. Street
Affiliation:
National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
S. E. Gilman
Affiliation:
Departments of Social and Behavioral Sciences, and Epidemiology, Harvard School of Public Health, Boston, MA, USA
A. J. Rosellini
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
M. B. Stein
Affiliation:
Departments of Psychiatry and Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA VA San Diego Healthcare System, San Diego, CA, USA
E. J. Bromet
Affiliation:
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
K. L. Cox
Affiliation:
US Army Public Health Command, Aberdeen Proving Ground, MD, USA
L. J. Colpe
Affiliation:
Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD, USA
C. S. Fullerton
Affiliation:
Department of Psychiatry, Uniformed Services University School of Medicine, Center for the Study of Traumatic Stress, Bethesda, MD, USA
M. J. Gruber
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
S. G. Heeringa
Affiliation:
Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
L. Lewandowski-Romps
Affiliation:
Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
R. J. A. Little
Affiliation:
Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
J. A. Naifeh
Affiliation:
Department of Psychiatry, Uniformed Services University School of Medicine, Center for the Study of Traumatic Stress, Bethesda, MD, USA
M. K. Nock
Affiliation:
Department of Psychology, Harvard University, Cambridge, MA, USA
N. A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
M. Schoenbaum
Affiliation:
Office of Science Policy, Planning and Communications, National Institute of Mental Health, Bethesda, MD, USA
R. J. Ursano
Affiliation:
Department of Psychiatry, Uniformed Services University School of Medicine, Center for the Study of Traumatic Stress, Bethesda, MD, USA
A. M. Zaslavsky
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
R. C. Kessler*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
*
*Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. (Email: kessler@hcp.med.harvard.edu)
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Abstract

Background

The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) has found that the proportional elevation in the US Army enlisted soldier suicide rate during deployment (compared with the never-deployed or previously deployed) is significantly higher among women than men, raising the possibility of gender differences in the adverse psychological effects of deployment.

Method

Person-month survival models based on a consolidated administrative database for active duty enlisted Regular Army soldiers in 2004–2009 (n = 975 057) were used to characterize the gender × deployment interaction predicting suicide. Four explanatory hypotheses were explored involving the proportion of females in each soldier's occupation, the proportion of same-gender soldiers in each soldier's unit, whether the soldier reported sexual assault victimization in the previous 12 months, and the soldier's pre-deployment history of treated mental/behavioral disorders.

Results

The suicide rate of currently deployed women (14.0/100 000 person-years) was 3.1–3.5 times the rates of other (i.e. never-deployed/previously deployed) women. The suicide rate of currently deployed men (22.6/100 000 person-years) was 0.9–1.2 times the rates of other men. The adjusted (for time trends, sociodemographics, and Army career variables) female:male odds ratio comparing the suicide rates of currently deployed v. other women v. men was 2.8 (95% confidence interval 1.1–6.8), became 2.4 after excluding soldiers with Direct Combat Arms occupations, and remained elevated (in the range 1.9–2.8) after adjusting for the hypothesized explanatory variables.

Conclusions

These results are valuable in excluding otherwise plausible hypotheses for the elevated suicide rate of deployed women and point to the importance of expanding future research on the psychological challenges of deployment for women.

Keywords

ArmyArmy STARRSepidemiologygendermilitaryrisk factorssuicide
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 4 , March 2015 , pp. 717 - 726
Copyright
Copyright © Cambridge University Press 2014 

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