Discussing the Army/NIMH collaboration at a Pentagon media roundtable are (from l) Vice Chief of Staff of the Army Gen. Peter Chiarelli, Secretary of the Army Pete Geren, NIMH director Dr. Thomas Insel, principal investigator Dr. Robert Ursano, and co-principal investigators Dr. Ronald Kessler and Dr. Steven Heeringa.
Photo: Kenneth Frager, USUHS
The Pentagon was the setting for a media roundtable July 16 at which the U.S. Army and NIMH jointly announced the selection of a research consortium to conduct a $50 million study of suicide and mental health in the military. NIMH is carrying out the Army-funded Study to Assess Risk and Resilience in Servicemembers (Army STARRS) under a cooperative agreement mechanism. It is the largest study of mental health among military personnel ever undertaken.
The study is a 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 (NIH Record, Nov. 28, 2008). 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 a matter of the highest urgency for the United States Army,” said Army Secretary Pete Geren at the roundtable. “We are working at all levels to do everything we can to reverse this trend and we are excited about this partnership.” Also representing the Army at the roundtable were Vice Chief of Staff Gen. Peter Chiarelli; Brig. Gen. Colleen McGuire, chief of the Army suicide prevention task force; Lt. Gen. Eric Schoomaker, Army surgeon general; and Lt. Gen. Mike Rochelle, deputy chief of staff for Army G-1 (the Army’s human resources component).
There to discuss the scientific design of the study were NIMH director Dr. Thomas Insel and three of the four academic investigators of the study: principal investigator Dr. Robert Ursano of the Uniformed Services University of the Health Sciences; Dr. Ron Kessler, Harvard University; and Dr. Steven Heeringa, University of Michigan (co-principal investigator Dr. John Mann of Columbia University could not attend).
According to Insel, the study is in a sense “a Framingham study for mental health.” The goal is to identify as quickly as possible risk and protective factors for suicide among soldiers and to provide a scientific basis for effective and practical interventions to reduce suicide rates and address associated mental health problems.
Insel pointed out that suicide is a large problem for the civilian sector as well as the military; in addition to providing information on risk and resilience for use in an Army context, the study will generate information that will be of great use for the nation.
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 in Iraq and Afghanistan, including long and repeated deployments and traumatic stress, are important potential risk factors 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.
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.
The study will have several different components including reviews of archival data, baseline and follow-up surveys of active Army personnel and a retrospective case-control study of individual soldiers who have attempted or completed suicide. In some cases, saliva and blood samples will be collected for genetic and neurobiologic studies aimed at providing information on differences in emotional regulation that could lead to suicide.
Among the protective factors the study will examine are the programs already undertaken by the Army to foster mental health and resilience. Chiarelli, who is head of the Army campaign plan for health promotion, risk reduction and suicide prevention, said the Army wants “the scientific evidence” on what is working and what is not in their health promotion efforts. “We know this study will help inform how we implement that program down the road,” he added.
In order to make information from the study available to the Army quickly, the study plan includes progress reports on important emerging findings every 6 months with the first report coming this November. According to Insel, “We will be working as quickly as possible to give Gen. Chiarelli everything we can find out.”