By Lisa Rapaport
(Reuters Health) - Military suicides may be more likely after members leave the service than during active duty deployment, particularly if their time in uniform is brief, a U.S. study finds.
"It was certainly intuitive as the wars went on and suicides went up for people to assume that deployment was the reason, but our data show that that is too simplistic; when you look at the total population, deployment is not associated with suicide," said lead author Mark Reger, of Joint Base Lewis-McChord in Tacoma, Washington.
While the U.S. military has traditionally experienced lower suicide rates than the civilian population, suicides among active duty service members have surged in the past decade, almost doubling in the Army and the Marines Corps, Reger said.
To understand the link between deployment and suicide, Reger and colleagues analyzed military records for more than 3.9 million service members in active or reserve duty in support of the conflicts in Iraq and Afghanistan at any point from October 7, 2001 to December 31, 2007.
A total of 31,962 deaths occurred, including 5,041 suicides, by December 31, 2009.
Suicide rates were similar regardless of deployment status. There were 1,162 suicides among those who deployed and 3,879 among those who didn't, representing suicide rates per 100,000 person-years of 18.86 and 17.78, respectively.
Leaving the military significantly increased suicide risk, however, with a suicide rate of 26.06 after separating from service compared with 15.12 for those who remained in uniform. Those who left sooner had a greater risk, with a rate of 48.04 among those who spent less than a year in the military.
Service members with a dishonorable discharge were about twice as likely to commit suicide as those who had an honorable separation.
"This is the first time such a huge, comprehensive study has found an increased suicide risk among those who have separated from service, particularly if they served for less than four years or had an other than honorable discharge," said Rajeev Ramchand, a researcher in military mental health and suicide prevention at Rand Corporation who wasn't involved in the study.
It's possible that pre-deployment examinations may screen out people who have mental health problems, making those who deploy several times a healthier, more resilient group, said Dr. Alan Peterson, a psychologist at the University of Texas Health Science Center in San Antonio who specializes in combat-related post traumatic stress disorder (PTSD).
"Those who really struggle with a deployment don't go the second time," said Peterson, a retired military psychologist who wasn't involved in the study. "Early separation from the military is often a marker for something else."
For those contemplating suicide, access to firearms can exacerbate the problem, Peterson said. "It's a risk factor that sometimes gets overlooked, but we've seen when they don't have access to weapons they are less likely to kill themselves."
Some service members who leave the military early may have had risk factors for suicide such as mood disorders or substance abuse problems that contributed to their separation, particularly if they had a dishonorable discharge, said Dr. Christine Moutier, chief medical officer of the American Foundation for Suicide Prevention.
"Some of the dishonorable discharges may be related to having a mental health disorder and being unable to keep that behavior in check and breaking the rules, and some of the early separations may be people in distress who appropriately opted out of service," said Moutier, who wasn't involved in the study.
It isn't realistic to expect former service members to instantly reintegrate into their former civilian lives, but they may be experiencing serious mental health problems if they're not eating or sleeping or if they're extremely agitated or irritable, Moutier said.
"The lack of an association between deployment and suicide risk isn't surprising," she said. "At a very high level, these findings highlight the need for us to pay closer attention to what happens when people leave the military."
SOURCE: http://bit.ly/1BMzKsh JAMA Psychiatry, online April 1, 2015.
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