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Pre-existing Conditions

Improved screening and early, enhanced interventions may help reduce soldier suicide rate

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Sobering data gathered in the largest study to date of mental health risk and resilience among U.S. Army personnel indicate that nearly 50 percent of soldiers who attempt suicide did so for the first time before they enlisted. In addition, the research, reported in three papers published online March 3 in JAMA Psychiatry, showed that more than 75 percent of soldiers who currently have mental health disorders experienced the onset of these disorders before entering the service, and that nearly 60 percent of soldiers who had ever considered suicide had such thoughts before enlistment. According to the researchers, the findings indicate that reducing the high suicide rate among soldiers may require improvements in the screening of applicants and enhanced interventions for new soldiers who have mental health disorders.

The data were drawn from responses to a survey called Army STARRS, Army Study to Assess Risk and Resilience in Servicemembers, which was developed through a partnership between the Army and the National Institute of Mental Health. The papers detail the different strategies the research teams used to evaluate suicide risk and protective factors among service members. One of the papers compared the prevalence of mental disorders among Army and civilian populations; its lead author is Ronald Kessler, the McNeil Family Professor of Health Care Policy at HMS.

“Some of the differences in disorder rates are truly remarkable,” says Kessler. “The rate of major depression is five times as high among soldiers as civilians, intermittent explosive disorder six times as high, and PTSD nearly fifteen times as high.”

The most common disorders captured in the survey were attention deficit hyperactivity disorder (ADHD) and intermittent explosive disorder (IED), which are recurrent and uncontrollable anger attacks, Kessler says.

The findings suggest that, before enlistment, the rate of anxiety disorders and depression, so-called internalized disorders, was not higher among soldiers than among civilians, but that the rate among soldiers rose after enlistment. By contrast, behavioral disorders such as ADHD, IED, and substance abuse were much more common among people who enlisted in the Army than among those who did not. Rates of these disorders rose even more following enlistment.

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