PENTAGON—The number of suicides in the Army has declined from earlier this year as the Army has stepped up its suicide prevention efforts, but officials say they do not know exactly what is causing that decline, or whether it will continue.

As of mid July this year, there were 92 suicides in the Army. A total of 41 of those suicides were reported in the first 2 months, compared with 51 in the last 4 1/2 months.

Earlier this year the Army had mandated that leaders and troops complete a suicide prevention training initiative, but Army officials said that they could not determine whether this was responsible for the recent decline. “The last several months have been lower, but we are not here to tell you we have turned the corner. Next month could be another tragic month. We are putting a tremendous effort into this, and perhaps it has helped prevent a suicide, or at the least, delayed it. We don’t know,” Army Secretary Pete Geren said at a Pentagon briefing last month.

The National Institute of Mental Health is partnering with the Army on the largest study to date on suicide and mental health among military personnel. Secretary Geren said that the Army is hoping this study will shed light on why soldiers are committing suicide and what programs work best in addressing the problem. “We hope that as we move through this study, we will be able to make a better connection as to what did and didn’t work. So we are moving many, different initiatives against it,” Secretary Geren said.

While there are numerous military suicide materials available to commanders, some of it may not be as effective as other prevention material, officials said. “There isn’t a lack of material out there. The problem is that there is too much material,” according to Army Vice Chief of Staff Gen Peter Chiarelli, who added that the study would help the Army “get rid of some of the things out there” that are not effective.

Factors Contributing to Suicide

The $50 million 5-year study was announced last October and is funded by the Army. It was announced last month that the study will be carried out by a team of investigators from the Uniformed Services University of the Health Sciences, University of Michigan, Harvard Medical Center, and Columbia University.

Study investigators are aiming to identify risk and protective factors for suicide among soldiers, and provide a scientific basis for interventions to reduce suicide rates. “We are endeavoring to determine the factors that both increase risk and what are the factors that are protective,” said Dr Robert Ursano, MD, the project director.

Officials said that they do not believe that repeated deployments are the primary cause of Army suicides. “Our experience up until now is that one-third of the people who commit suicide have never deployed,” Secretary Geren said. “One-third commit suicide while they are on deployment, and one-third have deployed at some point. Our data would not support the contention that there is a direct relationship between deployment experience and suicidal behavior.”

Doctor Ursano said that there is no question that repeated deployments increase stress on the soldier and their families, but said “it is a much more complicated picture.”

NIMH Director Thomas Insel, MD, compared the goal of understanding the factors that contribute to suicide to the goal of researchers in the 1948 Framingham Heart Study to understand the factors that contribute to Cardiovascular Disease.

In that study, a large group of participants who had not suffered a heart attack, or had apparent symptoms for one, were followed over a long period of time to understand the factors that contribute to Cardiovascular Disease. That research led to an understanding that cholesterol, stress, and family history were among the risk factors for Cardiovascular Disease. “This is in a sense a Framingham study for mental health. We’ve never had anything quite like that before,” said Dr Insel.

Large Scale Study

The study has multiple components and will include 500,000 soldiers over time, and likely some troops from the Marine Corps. Included in the study will be the approximately 80,000 new recruits who join the Army each year.

Ronald Keesler, PhD, a study investigator from Harvard, explained that the plan is to assess and follow all 80,000 of the new recruits. Researchers will obtain blood samples for them, psychological assessments, and follow them over to time to “see what we could have learned in the very first week that they were in the Army that could predict how they responded once they go in a complicated situation.”

In addition, an all-Army survey will be conducted and saliva and blood samples will be collected when possible for genetic and neurobiologic studies.

Investigators will also undertake a retrospective case-controlled study in which individual soldiers who have attempted or completed suicide will be matched against individuals with similar demographic characteristics. By comparing information gathered on those who have attempted or completed suicide with the controls, investigators are hoping for clues on risk and protective factors.

Results Will Help Civilians

Doctor Insel said that researchers are planning on updating the Army every 6 months. “Our plan is to have a progress report every 6 months that will go to the Army to help inform Gen Chiarelli and others as to what appear to be the most important findings,” he said. “We plan to have the first such report in November.”

Officials said that they are seeking to derive “actionable” results from the study that will allow the Army to implement the study’s findings

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