A cohort study published in JAMA Psychiatry described the effects of time-related variables on suicide attempts in soldiers, and the findings suggested that earlier first deployments and shorter breaks before a second deployment significantly increased the risk for suicide attempts.

Cultivating feelings of preparedness before first deployment and longer breaks between deployments (referred to as “dwell time”) have been focuses of the US Army, as previous research has associated these factors with positive mental health outcomes. This longitudinal, retrospective cohort study specifically examined second deployments, although it might be assumed that they are less challenging than the first.

The investigators used Army STARRS Historical Administrative Data from all active-duty Regular Army soldiers between 2004 and 2009 (N=975,057). In this group, 9791 had documented suicide attempts, which were identified using Army data and Department of Defense Suicide Event Reports.

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The analyses included soldiers with ≥2 years of continuous service and exactly 2 deployments, excluding Special Forces whose deployments are more frequent and atypical. This subgroup contained a total of 19,034 soldiers with 593 documented suicide attempts. Of these soldiers, 47% had a previous mental health diagnosis before their second deployment.

Analyses revealed that the likelihood of suicide attempts during or after a second deployment were twice as high in soldiers whose first deployment occurred within their initial 12 months of service, as opposed to soldiers who had served >12 months.

The risk for suicide also decreased as dwell time (mean 17.1 months in soldiers with documented suicide attempts) increased. Previous studies have recommended 30 to 36 months of dwell time to mitigate mental health issues.

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On the other hand, the duration of the first deployment was found to have no association with suicide risk during a second deployment.

The investigators cautioned that administrative data are not necessarily complete or accurate and that these findings might not generalize to other periods of military conflict. They also noted that while they studied soldiers with exactly 2 deployments, the target group may be “affected by the nonrandom nature of US Army attrition and deployment.”


Ursano R, Kessler R, Naifeh J, et al. Associations of time-related deployment variables with risk of suicide attempt among soldiers: results from the army study to assess risk and resilience in servicemembers (Army STARRS) [published online April 18, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2018.0296