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Understanding the elevated suicide risk of female soldiers during deployments

  • A. E. Street (a1) (a2), S. E. Gilman (a3), A. J. Rosellini (a4), M. B. Stein (a5) (a6), E. J. Bromet (a7), K. L. Cox (a8), L. J. Colpe (a9), C. S. Fullerton (a10), M. J. Gruber (a4), S. G. Heeringa (a11), L. Lewandowski-Romps (a11), R. J. A. Little (a12), J. A. Naifeh (a10), M. K. Nock (a13), N. A. Sampson (a4), M. Schoenbaum (a14), R. J. Ursano (a10), A. M. Zaslavsky (a4) and R. C. Kessler (a4)...
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.

Copyright
Corresponding author
* 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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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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