The National Institute of Mental Health (NIMH) has announced that an interdisciplinary team of four research institutions will carry out the largest study of suicide and mental health among military personnel ever undertaken, with $50 million in funding from the U.S. Army. Study investigators aim to move quickly to identify risk and protective factors for suicide among soldiers and provide a science base for effective and practical interventions to reduce suicide rates and address associated mental health problems.
The study is a direct response to the Army's request to NIMH to enlist the most promising scientific approaches for addressing the rising suicide rate among soldiers. A memorandum of agreement between NIMH and the Army, signed in October 2008, authorized NIMH to undertake the investigation with Army funding. Suicide rates among Army personnel have risen substantially since the beginning of the current conflicts in Iraq and Afghanistan despite major surveillance and intervention efforts introduced by the Army to prevent suicides over this period.
"This is an extraordinary opportunity to assist the Army in addressing a pressing military health issue," said NIMH Director Thomas R. Insel, M.D. "In addition to helping our armed forces serve the mental health needs of servicemen and women, the study will generate information on suicide risk and protective factors in a large population that will help us better understand suicide, and how to prevent it, in the public at large."
Suicide is the fourth leading cause of death among 25- to 44-year-olds in the United States. Historically, the suicide rate has been lower in the military than among civilians. In 2008 that pattern was reversed, with the suicide rate in the Army exceeding the age-adjusted rate in the civilian population (20.2 out of 100,000 vs. 19.2). While the stresses of the current wars, including long and repeated deployments and post-traumatic stress, are important potential contributors for research to address, suicidal behavior is a complex phenomenon. The study will examine a wide range of factors related to and independent of military service, including unit cohesion, exposure to combat-related trauma, personal and economic stresses, family history, childhood adversity and abuse, and overall mental health.
Four institutions will collaboratively conduct an epidemiologic study of mental health, psychological resilience, suicide risk, suicide-related behaviors, and suicide deaths in the U.S. Army. The consortium brings together research teams that are internationally known for their expertise and experience in research on military health, health and behavior surveys, epidemiology, and suicide, including genetic and neurobiological factors involved in suicidal behavior. Project director Robert Ursano, M.D., is at the Uniformed Services University of the Health Sciences, Bethesda, Md. Consortium principal investigators are Steven Heeringa, Ph.D., at the University of Michigan, Ann Arbor; Ronald Kessler, Ph.D., Harvard Medical School, Cambridge, Mass.; and John Mann, M.D., at Columbia University, New York City.
The study will use several strategies to generate information on risk and protective factors:
- The Army already has a rich archive of data on its personnel. Study investigators will work to consolidate information from different databases and use this resource to identify possible suicide risk and protective factors.
- Investigators will undertake a retrospective case-control study in which individual soldiers who have attempted suicide with or without fatal outcomes (cases) will be matched with individuals with similar demographic characteristics (controls). Comparison of information gathered on cases and controls should provide clues to risk and protective factors.
- A survey for which 90,000 active Army personnel representative of the entire Army will be contacted will provide information on the prevalence of suicide-related behavior and risk and protective factors. When possible, saliva and blood samples will be collected for genetic and neurobiologic studies.
- All 80,000 to 120,000 recruits who enter the Army in each of the first three years of the study will be asked to participate in a survey similar to the all-Army survey above.
This research will encompass active duty Army personnel across all phases of service, including members of the National Guard and Reserves. Soldiers' confidentiality will be protected as investigators explore the nature of risk and protective factors and the timing of events that could influence risk, such as time since enlistment and deployment status and history.
Although planned to continue for 5 years, the study is designed to be able to identify quickly potential risk factors that can inform the continuing research project and the Army's ongoing efforts to prevent suicide among its personnel. Identification of risk and protective factors-including existing prevention strategies that show effectiveness in reducing suicide risk—is a means to the end of developing evidence-based interventions that are readily applicable in a military context and can be put into action quickly to reverse the increase in suicide rates.