Predictors for Attempting Suicide Among Members of the US Military With Suicidal Ideation

Caucasian male veteran squeezes camouflage uniform hat during counseling session. Close up is of the man holding the hat.
A team of investigators sought to identify predictors of a suicide attempt among US soldiers receiving a diagnosis of suicidal ideation.

Among American army soldiers, the first 30 days after receiving a diagnosis of suicidal ideation was found to be associated with the greatest risk for an attempted suicide, according to study findings published in the American Journal of Psychiatry.

Data were sourced the from Army STARRS Historical Administrative Data Study, which comprised information from 38 Army and Department of Defense administrative data systems collected between 2004 and 2009. Soldiers (N=975,057) were assessed for demographic characteristics, suicidal ideation, and suicide attempt.

Soldiers with a diagnosis of suicidal ideation (n=11,178) were mostly men (81.7%), aged 29 years and younger (84.8%), White (71.7%), had completed high school (65.7%), and had never married (52.7%). The group of soldiers with suicidal ideation consisted of individuals who had enlisted when they were younger than <21 years (64.1%), had never been deployed (57.7%), and were in their first 2 years of service (52.7%).

A total of 830 (7.4%) individuals went on to attempt suicide, nearly half of whom attempted within 30 days of receiving a suicidal ideation diagnosis (46.3%). Risk for suicide attempt was highest the day after diagnosis (10.1 per 1000 soldiers).

Suicide attempt during the first 30 days was found to be associated with receiving a diagnosis of sleep disorder on the same day as a diagnosis of suicidal ideation (odds ratio [OR], 2.1; 95% CI, 1.0-4.1; P <.05), age younger than 21 years (OR, 1.8; 95% CI, 1.1-2.9; P <.05), being a combat medic (OR, 1.7; 95% CI, 1.2-2.3; P <.05), being of female sex (OR, 1.4; 95% CI, 1.1-1.7; P <.05), and having served 1 to 2 years in  the military (OR, 1.4; 95% CI, 1.0-1.8; P <.05).

Significant predictors of not attempting suicide by day 30 were Black ethnicity (OR, 0.6; 95% CI, 0.4-0.8; P <.05), having a rank above E4 (OR, 0.7; 95% CI, 0.6-0.9; P <.05), receiving a diagnosis of anxiety on the same day as a diagnosis of suicidal ideation (OR, 0.7; 95% CI, 0.5-1.0; P <.05), having marital problems (OR, 0.7; 95% CI, 0.5-0.9; P <.05), and having been deployed (OR, 0.8; 95% CI, 0.6-1.0; P <.05).

This study may have been limited by sourcing data from administrative records, which may be prone to incomplete or incorrect information.

These data indicated that risk for an attempted suicide was increased during the first 30 days after diagnosis of suicidal ideation among US Army soldiers. Women, combat medics, and those with a sleep disorder were at increased risk of attempting suicide.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Mash HBM, Ursano RJ, Kessler RC, et al. Predictors of suicide attempt within 30 days after first medically documented suicidal ideation in U.S. Army soldiers. Am J Psychiatry. Published online September 1, 2021. doi:10.1176/appi.ajp.2021.20111570