In the largest study of its kind, military medical researchers have concluded that deployments to war zones and exposure to combat were not major factors behind a significant increase in suicides among military personnel from 2001 to 2008, according to a paper published Tuesday.
The study, published online by the Journal of the American Medical Association, corroborates what many military medical specialists have been saying for years: that the forces underlying the spike in military suicides are similar to those in the civilian world. They include mental illness, substance abuse, and financial and relationship problems.
“The findings from this study are not consistent with the assumption that specific deployment-related characteristics, such as length of deployment, number of deployments, or combat experiences, are directly associated with increased suicide risk,” the authors, based at the Naval Health Research Center in San Diego, wrote. “Instead, the risk factors associated with suicide in this military population are consistent with civilian populations, including male sex and mental disorders.”
But even as it points to nondeployment factors as paramount, the study underscores the complex interplay of war and the mental health of troops, even those who never left the United States. It suggests that the stresses of 12 years of war may have worn on all service members, creating work and travel demands far outstripping those borne by peacetime troops.
“Perhaps it’s not being deployed so much as being in a war during a high-stress time period,” Dr. Nancy Crum-Cianflone, the principal investigator for the Millennium Cohort Study, which provided much of the raw data for the study, said in an interview.
Critics of the study said that, because its analysis ended with data from 2008, it might underestimate the impact of multiple deployments and traumatic brain injuries caused by roadside bombs.
“Why would the authors repeatedly insist that there is no association between combat and suicide?” asked Dr. Stephen N. Xenakis, a psychiatrist and retired Army brigadier general. “The careful analysis of bad data generates poor evidence.”
Cynthia LeardMann, the lead author on the study, said the research team planned to update the study to include data through 2012.
But she expressed confidence that its bottom line conclusions would remain the same.
Yet even providers of mental health care and advocates for veterans who praised the quality of the study cautioned that its findings should not be oversimplified to suggest that deployment has nothing to do with suicide.
Those providers and advocates say that deployment can prompt or intensify problems that are direct causes of suicidal behavior, including post-traumatic stress disorder, depression, and substance abuse.