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Articles   |    
Suicidal Behaviors and the Use of Mental Health Services Among Active Duty Army Soldiers
Jodi B. A. McKibben, Ph.D.; Carol S. Fullerton, Ph.D.; Holly B. Herberman Mash, Ph.D.; Matthew K. Nock, Ph.D.; James A. Naifeh, Ph.D.; Ronald C. Kessler, Ph.D.; Murray B. Stein, M.D., M.P.H.; Robert J. Ursano, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201200460
View Author and Article Information

Dr. McKibben, Dr. Fullerton, Dr. Herberman Mash, Dr. Naifeh, and Dr. Ursano are with the Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Dr. McKibben is also with the Department of Psychology, West Chester University, West Chester, Pennsylvania. Dr. Nock is with the Department of Psychology, Harvard University, Cambridge, Massachusetts. Dr. Kessler is with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Stein is with the Departments of Psychiatry and of Family and Preventive Medicine, University of California, San Diego. Send correspondence to Dr. Fullerton (e-mail: cfullert@erols.com).

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  U.S. Army personnel experience a significant mental health burden, particularly during times of war and multiple deployments. This study identified rates of suicidality (seriously considering or attempting suicide) and types of mental health services used in the past 12 months by active duty Army soldiers.

Methods  This study used the 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel, which sampled 10,400 Army soldiers from a total population of 508,088 soldiers. Mental health service utilization included receiving counseling or therapy from a general medical doctor, receiving counseling or therapy from a mental health professional, and being prescribed medications for depression, anxiety, or sleep. Suicidality was assessed via self-report questions.

Results  Thirteen percent had seriously considered or attempted suicide at some point in their lives, 7% since joining the military. One percent who reported suicidality since joining the Army reported having considered or attempted suicide in the past year. After the analyses adjusted for sociodemographic factors, soldiers who seriously considered or attempted suicide since joining the military versus those who did not were 1.71 times more likely to have used a mental health service, 2.33 times more likely to have used two or more types of services, 1.82 times more likely to have seen a mental health specialist, and 1.67 times more likely to have received medication in the past year.

Conclusions  Understanding the relationship between suicidal thoughts and behaviors and the specific levels and types of mental health services received in this military population is important for health care provision and planning.

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Table 1Suicidality among active duty soldiers before and after joining the U.S. Armya
Table Footer Note

a The observed sample consisted of 5,476 soldiers who responded to the 2008 Department of Defense Survey of Health Related Behaviors. The respondents represented a weighted sample of 470,140 soldiers.

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Table 2Use of mental health services in the past year among active duty soldiers, by suicidality before and after joining the U.S. Armya
Table Footer Note

a The observed sample consisted of 5,100 soldiers who responded to the 2008 Department of Defense Survey of Health Related Behaviors. The respondents represented a weighted sample of 437,395 soldiers.

Table Footer Note

b Counseling or therapy from a mental health professional and medication prescription for depression, anxiety, or sleep problems

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Table 3Likelihood of use of mental health services predicted by suicidality among active duty Army soldiersa
Table Footer Note

a The observed sample consisted of 5,100 soldiers who responded to the 2008 Department of Defense Survey of Health Related Behaviors. The respondents represented a weighted sample of 437,395 soldiers. Reference groups for all analyses were soldiers who did not use the service.

Table Footer Note

b Adjusted for gender, race, marital status, and enlisted status. Analyses of lifetime suicidality were also adjusted for suicidality since joining the military or in the past year. Analyses of suicidality since joining the military were also adjusted for lifetime suicidality and suicidality in the past year. Analyses of suicidality in the past year were also adjusted for lifetime suicidality and suicidality since joining the military. df=1

Table Footer Note

c OR/RRR, odds ratio or relative risk ratio

Table Footer Note

*p<.05, **p<.01, ***p<.001

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References

Andrews  G;  Sanderson  K;  Beard  J:  Burden of disease: methods of calculating disability from mental disorder.  British Journal of Psychiatry 173:123–131, 1998
[CrossRef] | [PubMed]
 
Web-Based Injury Statistics Query and Reporting System (WISQARS). Atlanta, Ga, Centers for Disease Control and Prevention. Available at www.cdc.gov/ncipc/wisquars. Accessed June 28, 2012
 
Rockett  IRH;  Regier  MD;  Kapusta  ND  et al:  Leading causes of unintentional and intentional injury mortality: United States, 2000–2009.  American Journal of Public Health 102:e84–e92, 2012
[CrossRef] | [PubMed]
 
Nock  MK;  Borges  G;  Bromet  EJ  et al:  Suicide and suicidal behavior.  Epidemiologic Reviews 30:133–154, 2008
[CrossRef] | [PubMed]
 
Hoge  CW;  Auchterlonie  JL;  Milliken  CS:  Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan.  JAMA 295:1023–1032, 2006
[CrossRef] | [PubMed]
 
Boardman  AP;  Grimbaldeston  AH;  Handley  C  et al:  The North Staffordshire Suicide Study: a case-control study of suicide in one health district.  Psychological Medicine 29:27–33, 1999
[CrossRef] | [PubMed]
 
Hoge  CW;  Castro  CA:  Preventing suicides in US service members and veterans: concerns after a decade of war.  JAMA 308:671–672, 2012
[CrossRef] | [PubMed]
 
Hill  JV;  Johnson  RC;  Barton  RA:  Suicidal and homicidal soldiers in deployment environments.  Military Medicine 171:228–232, 2006
[PubMed]
 
Nelson  R:  Suicide rates rise among soldiers in Iraq.  Lancet 363:300, 2004
[CrossRef] | [PubMed]
 
Kuehn  BM:  Soldier suicide rates continue to rise: military, scientists work to stem the tide.  JAMA 301:1111–1113, 2009
[CrossRef] | [PubMed]
 
Tarrier  N;  Taylor  K;  Gooding  P:  Cognitive-behavioral interventions to reduce suicide behavior: a systematic review and meta-analysis.  Behavior Modification 32:77–108, 2008
[CrossRef] | [PubMed]
 
van der Feltz-Cornelis  CM;  Sarchiapone  M;  Postuvan  V  et al:  Best practice elements of multilevel suicide prevention strategies: a review of systematic reviews.  Crisis 32:319–333, 2011
[CrossRef] | [PubMed]
 
Weinberg  I;  Ronningstam  E;  Goldblatt  MJ  et al:  Strategies in treatment of suicidality: identification of common and treatment-specific interventions in empirically supported treatment manuals.  Journal of Clinical Psychiatry 71:699–706, 2010
[CrossRef] | [PubMed]
 
Brown  GK;  ten Have  T;  Henriques  GR  et al:  Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial.  JAMA 294:563–570, 2005
[CrossRef] | [PubMed]
 
Luoma  JB;  Martin  CE;  Pearson  JL:  Contact with mental health and primary care providers before suicide: a review of the evidence.  American Journal of Psychiatry 159:909–916, 2002
[CrossRef] | [PubMed]
 
Bruffaerts  R;  Demyttenaere  K;  Hwang  I  et al:  Treatment of suicidal people around the world.  British Journal of Psychiatry 199:64–70, 2011
[CrossRef] | [PubMed]
 
McKibben  JB;  Fullerton  CS;  Gray  CL  et al:  Mental health service utilization in the US Army.  Psychiatric Services 64:347–353, 2013
[CrossRef] | [PubMed]
 
Trofimovich  L;  Skopp  NA;  Luxton  DD  et al:  Health care experiences prior to suicide and self-inflicted injury, active component, US armed forces, 2001–2010.  Medical Surveillance Monthly Report 19:2–6, 2012
[PubMed]
 
Bray  RM;  Pemberton  MR;  Hourani  LL  et al:  2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel .  Research Triangle Park, NC,  Research Triangle Institute, 2009
 
Crosby  AE;  Han  B;  Ortega  LA  et al:  Suicidal thoughts and behaviors among adults aged ≥18 years—United States, 2008–2009.  Morbidity and Mortality Weekly Report 60:1–22, 2011
 
Kessler  RC;  Berglund  P;  Borges  G  et al:  Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003.  JAMA 293:2487–2495, 2005
[CrossRef] | [PubMed]
 
Kessler  RC;  Borges  G;  Walters  EE:  Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey.  Archives of General Psychiatry 56:617–626, 1999
[CrossRef] | [PubMed]
 
Kim  PY;  Thomas  JL;  Wilk  JE  et al:  Stigma, barriers to care, and use of mental health services among active duty and National Guard soldiers after combat.  Psychiatric Services 61:582–588, 2010
[CrossRef] | [PubMed]
 
Fikretoglu  D;  Guay  S;  Pedlar  D  et al:  Twelve month use of mental health services in a nationally representative, active military sample.  Medical Care 46:217–223, 2008
[CrossRef] | [PubMed]
 
Hoge  CW;  Castro  CA;  Messer  SC  et al:  Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.  New England Journal of Medicine 351:13–22, 2004
[CrossRef] | [PubMed]
 
Kim  PY;  Britt  TW;  Klocko  RP  et al:  Stigma, negative attitudes about treatment, and utilization of mental health care among soldiers.  Military Psychology 23:65–81, 2011
[CrossRef]
 
Wang  PS;  Berglund  P;  Olfson  M  et al:  Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication.  Archives of General Psychiatry 62:603–613, 2005
[CrossRef] | [PubMed]
 
Burnam  MA;  Meredith  LS;  Helmus  TC  et al:  Systems of care: challenges and opportunities to improve access to high-quality care; in  Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery . Edited by Tanielian  TL;  Jaycox  LH.  Santa Monica, Calif,  Rand, 2008
 
Carabajal S: Army expanding successful embedded behavioral health program. www.army.mil, Nov 17, 2011. Available at www.army.mil/article/69479
 
Ramchand  R;  Acosta  J;  Burns  R  et al:  The War Within: Preventing Suicide in the US Military .  Santa Monica, Calif,  Rand, 2011
 
Oordt  MS;  Jobes  DA;  Rudd  MD  et al:  Development of a clinical guide to enhance care for suicidal patients.  Professional Psychology, Research and Practice 36:208–218, 2005
[CrossRef]
 
Oordt  MS;  Jobes  DA;  Fonseca  VP  et al:  Training mental health professionals to assess and manage suicidal behavior: can provider confidence and practice behaviors be altered? Suicide and Life-Threatening Behavior 39:21–32, 2009
[CrossRef] | [PubMed]
 
Jobes  DA;  Lento  R;  Brazaitis  K:  An evidence-based clinical approach to suicide prevention in the Department of Defense: the Collaborative Assessment and Management of Suicidality (CAMS).  Military Psychology 24:604–623, 2012
[CrossRef]
 
Bray  RM;  Pemberton  MR;  Lane  ME  et al:  Substance use and mental health trends among US military active duty personnel: key findings from the 2008 DoD Health Behavior Survey.  Military Medicine 175:390–399, 2010
[CrossRef] | [PubMed]
 
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