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Largest Ever Study of Military Suicide Begins

The National Institute of Mental Health (NIMH) has announced that an
interdisciplinary team of four research institutions will carry out the
largest study of suicide and mental health among military personnel
ever undertaken, with $50 million in funding from the U.S. Army. Study
investigators aim to move quickly to identify risk and protective
factors for suicide among soldiers and provide a science base for
effective and practical interventions to reduce suicide rates and
address associated mental health problems.

The study is a direct response to the Army's request to NIMH to enlist
the most promising scientific approaches for addressing the rising
suicide rate among soldiers. A memorandum of agreement between NIMH
and the Army, signed in October 2008, authorized NIMH to undertake the
investigation with Army funding. Suicide rates among Army personnel
have risen substantially since the beginning of the current conflicts
in Iraq and Afghanistan despite major surveillance and intervention
efforts introduced by the Army to prevent suicides over this period.

"This is an extraordinary opportunity to assist the Army in addressing
a pressing military health issue," said NIMH Director Thomas R. Insel,
M.D. "In addition to helping our armed forces serve the mental health
needs of servicemen and women, the study will generate information on
suicide risk and protective factors in a large population that will
help us better understand suicide, and how to prevent it, in the public
at large."

Suicide is the fourth leading cause of death among 25- to 44-year-olds
in the United States. Historically, the suicide rate has been lower in
the military than among civilians. In 2008 that pattern was reversed,
with the suicide rate in the Army exceeding the age-adjusted rate in
the civilian population (20.2 out of 100,000 vs. 19.2). While the
stresses of the current wars, including long and repeated deployments
and post-traumatic stress, are important potential contributors for
research to address, suicidal behavior is a complex phenomenon. The
study will examine a wide range of factors related to and independent
of military service, including unit cohesion, exposure to
combat-related trauma, personal and economic stresses, family history,
childhood adversity and abuse, and overall mental health.

Four institutions will collaboratively conduct an epidemiologic study
of mental health, psychological resilience, suicide risk,
suicide-related behaviors, and suicide deaths in the U.S. Army. The
consortium brings together research teams that are internationally
known for their expertise and experience in research on military
health, health and behavior surveys, epidemiology, and suicide,
including genetic and neurobiological factors involved in suicidal
behavior. Project director Robert Ursano, M.D., is at the Uniformed
Services University of the Health Sciences, Bethesda, Md. Consortium
principal investigators are Steven Heeringa, Ph.D., at the University
of Michigan, Ann Arbor; Ronald Kessler, Ph.D., Harvard Medical School,
Cambridge, Mass.; and John Mann, M.D., at Columbia University, New York

The study will use several strategies to generate information on risk and protective factors:

-- The Army already has a rich archive of data on its personnel. Study
investigators will work to consolidate information from different
databases and use this resource to identify possible suicide risk and
protective factors.

-- Investigators will undertake a retrospective case-control study in
which individual soldiers who have attempted suicide with or without
fatal outcomes (cases) will be matched with individuals with similar
demographic characteristics (controls). Comparison of information
gathered on cases and controls should provide clues to risk and
protective factors.

-- A survey for which 90,000 active Army personnel representative of
the entire Army will be contacted will provide information on the
prevalence of suicide-related behavior and risk and protective factors.
When possible, saliva and blood samples will be collected for genetic
and neurobiologic studies.

-- 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 survey
similar to the all-Army survey above.

This research will encompass active duty Army personnel across all
phases of service, including members of the National Guard and
Reserves. Soldiers' confidentiality will be protected as investigators
explore the nature of risk and protective factors and the timing of
events that could influence risk, such as time since enlistment and
deployment status and history.

Although planned to continue for 5 years, the study is designed to be
able to identify quickly potential risk factors that can inform the
continuing research project and the Army's ongoing efforts to prevent
suicide among its personnel. Identification of risk and protective
factors-including existing prevention strategies that show
effectiveness in reducing suicide risk-is a means to the end of
developing evidence-based interventions that are readily applicable in
a military context and can be put into action quickly to reverse the
increase in suicide rates.


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