Despite major efforts by the US Army to prevent suicide among military personnel, the rates of suicide among soldiers have continued to rise, doubling in the past five years with the wars in Afghanistan and Iraq. Faced with this reality, the Army asked the National Institute of Mental Health (NIMH) to develop a scientific approach to reducing suicide rates and addressing associated mental health problems, with a focus on effective and practical interventions. Through a competitive process, HCP Professor Ronald C. Kessler, PhD, and colleagues from three other institutions—the Uniformed Services University of the Health Sciences, University of Michigan, and Columbia University—were recently awarded funding for a major study of suicide in the armed forces. At nearly $70 million, this is the largest epidemiological study ever funded by NIMH, with $50 million coming from the Army.

The interdisciplinary teams of researchers in the five-year study will identify risk and protective factors for suicidal behaviors and mental disorders among soldiers, including members of the National Guard and Reserves, as well as among Marines. “Our study will generate evidence-based recommendations for the development and evaluation of suicide interventions that are readily applicable in a military context and can be put into action quickly to reverse the increase in suicide rates,” says Kessler, who is principal investigator for the Harvard Medical School site and an expert in psychiatric epidemiology. “And although our research is designed to address suicide among military personnel, it will also provide insights relevant to the general US population.”

According to the Centers for Disease Control and Prevention, suicide is the fourth leading cause of death among 25- to 44-year-olds in the United States, with the suicide rate traditionally lower for military personnel than for civilians. Beginning in 2008, however, the rate for those in the armed forces exceeded that of the general population. “Suicidal behavior is a complex phenomenon,” notes Kessler, “so in this study we will examine a wide range of factors, both related to and independent of military service.” These factors include unit cohesion, exposure to combat-related trauma, personal and economic stresses, family history, childhood adversity and abuse, and overall mental health.

This project is unique in a number of ways:

• The study is based on an extremely large sample of individuals about whom a great deal of baseline psychosocial and neurobiological data is known. The investigators will draw on the rich archive of Army personnel data and will consolidate information from several Army databases. They will also survey 90,000 active Army personnel, and all 80,000 to 120,000 recruits who enter the Army in each of the first three years of the study will be asked to participate in a similar survey.
• Study participants are in the age range in which one would normally expect to find first onset of many mental disorders.
• As military personnel, these individuals are exposed to extremely stressful life situations.
• Their daily routines are so closely constrained because of their military service that opportunities exist for intervention at individual, family, group, and population levels.
• The researchers will be able to follow these service members over several years.

“The results of our extensive analyses will lead to recommendations to the Army for new interventions aimed at reducing suicidality and mental illness among military personnel,” says Kessler. “We hope that our work will show a new way forward.”