Psychol Med. 2014 Oct 31:1-10. [Epub ahead of print]

Understanding the elevated suicide risk of female soldiers during deployments.

Street AE1, Gilman SE2, Rosellini AJ3, Stein MB4, Bromet EJ5, Cox KL6, Colpe LJ7, Fullerton CS8, Gruber MJ3, Heeringa SG9, Lewandowski-Romps L9, Little RJ10, Naifeh JA8, Nock MK11, Sampson NA3, Schoenbaum M12, Ursano RJ8, Zaslavsky AM3, Kessler RC3.

Author information

• 1National Center for PTSD, VA Boston Healthcare System,Boston,MA,USA.
• 2Departments of Social and Behavioral Sciences, and Epidemiology,Harvard School of Public Health,Boston,MA,USA.
• 3Department of Health Care Policy,Harvard Medical School,Boston,MA,USA.
• 4Departments of Psychiatry and Family and Preventive Medicine,University of California San Diego,La Jolla,CA,USA.
• 5Department of Psychiatry,Stony Brook University School of Medicine,Stony Brook,NY,USA.
• 6US Army Public Health Command,Aberdeen Proving Ground,MD,USA.
• 7Division of Services and Intervention Research, National Institute of Mental Health,Bethesda,MD,USA.
• 8Department of Psychiatry,Uniformed Services University School of Medicine,Center for the Study of Traumatic Stress,Bethesda,MD,USA.
• 9Institute for Social Research, University of Michigan,Ann Arbor,MI,USA.
• 10Department of Biostatistics,University of Michigan,Ann Arbor,MI,USA.
• 11Department of Psychology,Harvard University,Cambridge,MA,USA.
• 12Office of Science Policy,Planning and Communications,National Institute of Mental Health,Bethesda,MD,USA.

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.