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New study: Suicides not linked to combat exposure

Aug. 6, 2013 - 05:08PM   |  
Combat appears to have little or no influence on suicide rates among U.S. troops and veterans, according to a new military study.
Combat appears to have little or no influence on suicide rates among U.S. troops and veterans, according to a new military study. (Anja Niedringhaus / AP)
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A new study appears to reinforce the Defense Department’s assertion that suicide among troops is not tied to deployment stress or combat exposure.

For the past three years, a comprehensive Pentagon review of military suicides has shown that more than half of the service members who died by suicide never deployed and more than 80 percent had not seen combat.

Now a new DoD-backed study finds that military factors — mainly deployment and combat exposure — do not appear to put troops at an increased risk for suicide.

Instead, issues like mental health disorders and alcohol abuse seem to play a significant role, just as they do in civilian suicides.

In the study, published online today in the Journal of American Medicine, military researchers reviewed more than 150,000 service members’ records and questionnaires and compared them with the National Death Index and the DoD Medical Mortality Registry, sources containing information on troops suicides.

The review indicated that being male, drinking heavily and/or suffering from depression or bipolar disorder were associated more with completing suicide than deployment, regardless of the number of days spent deployed, number of deployments or length of combat exposure.

“We did not find any military-specific risk factors that are associated with the military suicides that have been occurring,” said Dr. Nancy Crum-Cianflone, director of the Defense Department’s Millennium Cohort Study Team.

The researchers also found that while mental health problems like substance abuse and depression indicated an increased risk of suicide, some disorders, such as post-traumatic stress, were not associated with increased risk.

The authors theorized that the increased rate of suicide in the military may be related to a rise in mental health disorders among those who join the military or a consequence of “cumulative occupational stresses” of military life, both in garrison and in combat zones.

“This provides evidence that continuing to screen and provide quality treatment for mental health disorders as well as alcohol-related problems are really the areas we need to focus on in terms of treating our service members and military veterans,” Naval Health Research Center analyst Cynthia LeardMann said.

Study limitations include the fact that the researchers examined personnel and suicides only from 2001 through 2008. The military saw a sharp rise in suicides starting around 2005.

The research also relies on databases that may not capture all suicides, since suicide often is not noted on death certificates or hidden by next-of-kin as the real cause of death.

Crum-Cianflone said her researchers are collecting and analyzing more recent data and also have a plan to examine the factors that play into suicide attempts.

They also are examining pre-service factors, such as medical and psychiatric histories, in a study called the Recruit Assessment Program.

From January through early July, 157 active-duty and mobilized National Guard and reserve members died by suicide, according to service-provided data.

Military suicides hit an all-time high in 2012 with 349, a rate of nearly one a day.

Crum-Cianflone said that she understands critics may be skeptical of a Pentagon-funded study that reports the rise in suicide is not related to war.

But she said her department has done significant research on the relationship between deployment and adverse health outcomes and has found associations in other cases.

In an editorial also published in JAMA on the new findings, Dr. Charles Engel of the Uniformed Services University of the Health Sciences in Bethesda., Md., said the findings offer “some potentially reassuring ways forward.”

“The major modifiable mental health antecedents of military suicides — mood disorders and alcohol misuse — are mental disorders for which effective treatments exist,” Engel wrote.

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