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Occupational differences in US Army suicide rates

  • R. C. Kessler (a1), M. B. Stein (a2) (a3), P. D. Bliese (a4), E. J. Bromet (a5), W. T. Chiu (a1), K. L. Cox (a6), L. J. Colpe (a7), C. S. Fullerton (a8), S. E. Gilman (a9), M. J. Gruber (a1), S. G. Heeringa (a10), L. Lewandowski-Romps (a10), A. Millikan-Bell (a6), J. A. Naifeh (a8), M. K. Nock (a11), M. V. Petukhova (a1), A. J. Rosellini (a1), N. A. Sampson (a1), M. Schoenbaum (a12), A. M. Zaslavsky (a1) and R. J. Ursano (a8)...



Civilian suicide rates vary by occupation in ways related to occupational stress exposure. Comparable military research finds suicide rates elevated in combat arms occupations. However, no research has evaluated variation in this pattern by deployment history, the indicator of occupation stress widely considered responsible for the recent rise in the military suicide rate.


The joint associations of Army occupation and deployment history in predicting suicides were analysed in an administrative dataset for the 729 337 male enlisted Regular Army soldiers in the US Army between 2004 and 2009.


There were 496 suicides over the study period (22.4/100 000 person-years). Only two occupational categories, both in combat arms, had significantly elevated suicide rates: infantrymen (37.2/100 000 person-years) and combat engineers (38.2/100 000 person-years). However, the suicide rates in these two categories were significantly lower when currently deployed (30.6/100 000 person-years) than never deployed or previously deployed (41.2–39.1/100 000 person-years), whereas the suicide rate of other soldiers was significantly higher when currently deployed and previously deployed (20.2–22.4/100 000 person-years) than never deployed (14.5/100 000 person-years), resulting in the adjusted suicide rate of infantrymen and combat engineers being most elevated when never deployed [odds ratio (OR) 2.9, 95% confidence interval (CI) 2.1–4.1], less so when previously deployed (OR 1.6, 95% CI 1.1–2.1), and not at all when currently deployed (OR 1.2, 95% CI 0.8–1.8). Adjustment for a differential ‘healthy warrior effect’ cannot explain this variation in the relative suicide rates of never-deployed infantrymen and combat engineers by deployment status.


Efforts are needed to elucidate the causal mechanisms underlying this interaction to guide preventive interventions for soldiers at high suicide risk.


Corresponding author

* Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. (Email:


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Armed Forces Health Surveillance Center (2012). Deaths by suicide while on active duty, active and reserve components, U.S. Armed Forces, 1998–2011. Medical Surveillance Monthly Reports 19, 710.
Armed Forces Staff College (1991). Joint Staff Officer's Guide 1991 (ed. Armed Forces Staff College and Department of the Army). National Defense University, Armed Forces Staff College: Norfolk, VA.
Bachynski, KE, Canham-Chervak, M, Black, SA, Dada, EO, Millikan, AM, Jones, BH (2012). Mental health risk factors for suicides in the US Army, 2007–8. Injury Prevention 18, 405412.
Belisle, JG, Wenke, JC, Krueger, CA (2013). Return-to-duty rates among US military combat-related amputees in the global war on terror: job description matters. Journal of Trauma and Acute Care Surgery 75, 279286.
Bell, NS, Harford, TC, Amoroso, PJ, Hollander, IE, Kay, AB (2010). Prior health care utilization patterns and suicide among U.S. Army soldiers. Suicide and Life-Threatening Behavior 40, 407415.
Black, SA, Gallaway, MS, Bell, MR, Ritchie, EC (2011). Prevalence and risk factors associated with suicides of Army soldiers 2001–2009. Military Psychology 23, 433.
Browning, SR, Westneat, SC, McKnight, RH (2008). Suicides among farmers in three southeastern states, 1990–1998. Journal of Agricultural Safety and Health 14, 461472.
Bryan, CJ, Griffith, JH, Pace, BT, Hinkson, K, Bryan, AO, Clemans, TA, Imel, ZE (2015). Combat exposure and risk for suicidal thoughts and behaviors among military personnel and veterans: a systematic review and meta-analysis. Suicide and Life-Threatening Behavior. Published online 8 April 2015. doi:10.1111/sltb.12163.
Carr, JR, Hoge, CW, Gardner, J, Potter, R (2004). Suicide surveillance in the U.S. Military – reporting and classification biases in rate calculations. Suicide and Life-Threatening Behavior 34, 233241.
Cornum, R, Matthews, MD, Seligman, ME (2011). Comprehensive soldier fitness: building resilience in a challenging institutional context. American Psychologist 66, 49.
Garvey Wilson, AL, Messer, SC, Hoge, CW (2009). U.S. military mental health care utilization and attrition prior to the wars in Iraq and Afghanistan. Social Psychiatry and Psychiatric Epidemiology 44, 473481.
Gilman, SE, Bromet, EJ, Cox, KL, Colpe, LJ, Fullerton, CS, Gruber, MJ, Heeringa, SG, Lewandowski-Romps, L, Millikan-Bell, AM, Naifeh, JA, Nock, MK, Petukhova, MV, Sampson, NA, Schoenbaum, M, Stein, MB, Ursano, RJ, Wessely, S, Zaslavsky, AM, Kessler, RC (2014). Sociodemographic and career history predictors of suicide mortality in the United States Army 2004–2009. Psychological Medicine 44, 25792592.
Gubata, ME, Piccirillo, AL, Packnett, ER, Cowan, DN (2013). Military occupation and deployment: descriptive epidemiology of active duty U.S. Army men evaluated for a disability discharge. Military Medicine 178, 708714.
Hanigan, IC, Butler, CD, Kokic, PN, Hutchinson, MF (2012). Suicide and drought in New South Wales, Australia, 1970–2007. Proceedings of the National Academy of Sciences of the United States of America 109, 1395013955.
Hawton, K, Clements, A, Sakarovitch, C, Simkin, S, Deeks, JJ (2001). Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979–1995. Journal of Epidemiology and Community Health 55, 296300.
Hawton, K, Vislisel, L (1999). Suicide in nurses. Suicide and Life-Threatening Behavior 29, 8695.
Helmkamp, JC (1996). Occupation and suicide among males in the US Armed Forces. Annals of Epidemiology 6, 8388.
Hernan, MA, Robins, JM (2006). Estimating causal effects from epidemiological data. Journal of Epidemiology and Community Health 60, 578586.
Hoge, CW, Warner, CH, Castro, CA (2014). Mental health and the army. JAMA Psychiatry 71, 965966.
Huguet, N, Kaplan, MS, McFarland, BH (2014). The effects of misclassification biases on veteran suicide rate estimates. American Journal of Public Health 104, 151155.
Hyman, J, Ireland, R, Frost, L, Cottrell, L (2012). Suicide incidence and risk factors in an active duty US military population. American Journal of Public Health 102 (Suppl. 1), S138S146.
Kessler, RC, Colpe, LJ, Fullerton, CS, Gebler, N, Naifeh, JA, Nock, MK, Sampson, NA, Schoenbaum, M, Zaslavsky, AM, Stein, MB, Ursano, RJ, Heeringa, SG (2013). Design of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). International Journal of Methods in Psychiatric Research 22, 267275.
Kirin, SJ, Winkler, JD (1992). The Army Military Occupational Specialty Database. RAND Corporation: Santa Monica, CA.
Kleykamp, MA (2006). College, jobs, or the military? Enlistment during a time of war. Social Science Quarterly 87, 272290.
Larson, GE, Highfill-McRoy, RM, Booth-Kewley, S (2008). Psychiatric diagnoses in historic and contemporary military cohorts: combat deployment and the healthy warrior effect. American Journal of Epidemiology 167, 12691276.
Layne, M, Naftel, S, Thie, HJ, Kawata, JH (2001). Military Occupational Specialties: Change and Consolidation. RAND Corporation: Santa Monica, CA.
LeardMann, CA, Powell, TM, Smith, TC, Bell, MR, Smith, B, Boyko, EJ, Hooper, TI, Gackstetter, GD, Ghamsary, M, Hoge, CW (2013). Risk factors associated with suicide in current and former US military personnel. Journal of the American Medical Association 310, 496506.
Lindstrom, KE, Smith, TC, Wells, TS, Wang, LZ, Smith, B, Reed, RJ, Goldfinger, WE, Ryan, MA (2006). The mental health of U.S. military women in combat support occupations. Journal of Women's Health 15, 162172.
Maclean, A, Parsons, NL (2010). Unequal risk: combat occupations in the volunteer military. Sociological Perspectives: Official Publication of the Pacific Sociological Association 53, iiiiv.
Montes, KS, Weatherly, JN (2014). The relationship between personality traits and military enlistment: an exploratory study. Military Behavioral Health 2, 98104.
Morey, LC, Lowmaster, SE, Coldren, RL, Kelly, MP, Parish, RV, Russell, ML (2011). Personality Assessment Inventory profiles of deployed combat troops: an empirical investigation of normative performance. Psychological Assessment 23, 456462.
Neria, Y, Solomon, Z, Ginzburg, K, Dekel, R (2000). Sensation seeking, wartime performance, and long-term adjustment among Israeli war veterans. Personality and Individual Differences 29, 921932.
Niebuhr, DW, Gubata, ME, Oetting, AA, Weber, NS, Feng, X, Cowan, DN (2013). Personality Assessment Questionnaire as a pre-accession screen for risk of mental disorders and early attrition in U. S. Army recruits. Psychological Services 10, 378385.
Niebuhr, DW, Krampf, RL, Mayo, JA, Blandford, CD, Levin, LI, Cowan, DN (2011). Risk factors for disability retirement among healthy adults joining the U.S. Army. Military Medicine 176, 170175.
Nock, MK, Deming, CA, Fullerton, CS, Gilman, SE, Goldenberg, M, Kessler, RC, McCarroll, JE, McLaughlin, KA, Peterson, C, Schoenbaum, M, Stanley, B, Ursano, RJ (2013). Suicide among soldiers: a review of psychosocial risk and protective factors. Psychiatry 76, 97125.
Parmak, M, Mylle, JJ, Euwema, MC (2014). Sensation seeking and perceived need for structure moderate soldiers’ well-being before and after operational deployment. Military Behavioral Health 2, 7581.
Peterson, C, Park, N, Castro, CA (2011). Assessment for the U.S. Army Comprehensive Soldier Fitness program: the Global Assessment Tool. American Psychologist 66, 1018.
Reger, MA, Smolenski, DJ, Skopp, NA, Metzger-Abamukang, MJ, Kang, HK, Bullman, TA, Perdue, S, Gahm, GA (2015). Risk of suicide among US Military service members following Operation Enduring Freedom or Operation Iraqi Freedom deployment and separation from the US Military. JAMA Psychiatry 72, 561569.
SAS Institute Inc. (2010). SAS/STATR Software. SAS Institute Inc.: Cary, NC.
Schlesselman, JJ (1982). Case–Control Studies: Design, Conduct, Analysis. Oxford University Press: New York.
Schoenbaum, M, Kessler, RC, Gilman, SE, Colpe, LJ, Heeringa, SG, Stein, MB, Ursano, RJ, Cox, KL (2014). Predictors of suicide and accident death in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS): results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). JAMA Psychiatry 71, 493503.
Street, AE, Gilman, SE, Rosellini, AJ, Stein, MB, Bromet, EJ, Cox, KL, Colpe, LJ, Fullerton, CS, Gruber, MJ, Heeringa, SG, Lewandowski-Romps, L, Little, RJA, Naifeh, JA, Nock, MK, Sampson, NA, Schoenbaum, MA, Ursano, RJ, Zaslavsky, AM, Kessler, RC (2015). Understanding the elevated suicide risk of female soldiers during deployments. Psychological Medicine 45, 717726.
Trofimovich, L, Reger, MA, Luxton, DD, Oetjen-Gerdes, LA (2013). Suicide risk by military occupation in the DoD active component population. Suicide and Life-Threatening Behavior 43, 274278.
Ursano, RJ, Colpe, LJ, Heeringa, SG, Kessler, RC, Schoenbaum, M, Stein, MB (2014). The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Psychiatry 77, 107119.
US Army (2015). Careers & Jobs ( Accessed April 2015.
Willett, JB, Singer, JD (1993). Investigating onset, cessation, relapse, and recovery: why you should, and how you can, use discrete-time survival analysis to examine event occurrence. Journal of Consulting and Clinical Psychology 61, 952965.
Wilson, J, Jones, M, Fear, NT, Hull, L, Hotopf, M, Wessely, S, Rona, RJ (2009). Is previous psychological health associated with the likelihood of Iraq War deployment? An investigation of the “healthy warrior effect”. American Journal of Epidemiology 169, 13621369.
Yip, PS, Caine, E, Yousuf, S, Chang, SS, Wu, KC, Chen, YY (2012). Means restriction for suicide prevention. Lancet 379, 23932399.


Occupational differences in US Army suicide rates

  • R. C. Kessler (a1), M. B. Stein (a2) (a3), P. D. Bliese (a4), E. J. Bromet (a5), W. T. Chiu (a1), K. L. Cox (a6), L. J. Colpe (a7), C. S. Fullerton (a8), S. E. Gilman (a9), M. J. Gruber (a1), S. G. Heeringa (a10), L. Lewandowski-Romps (a10), A. Millikan-Bell (a6), J. A. Naifeh (a8), M. K. Nock (a11), M. V. Petukhova (a1), A. J. Rosellini (a1), N. A. Sampson (a1), M. Schoenbaum (a12), A. M. Zaslavsky (a1) and R. J. Ursano (a8)...


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