Author Affiliations: Walter Reed Army Institute of Research, Silver Spring, Maryland (Dr Hoge); and US Army Medical Research and Materiel Command, Fort Detrick, Maryland (Dr Castro).
Before the wars in Iraq and Afghanistan, the incidence of suicide in active duty US service members was consistently 25% lower than that in civilians, attributable to “healthy-worker” effects from career selection factors and universal access to health care.1 Between 2005 and 2009, the incidence of suicide in Army and Marine personnel nearly doubled. From 2009 through the first half of 2012, the incidence of suicide among Army soldiers remained elevated (22 per 100 000 per year), with the number dying of suicide each year exceeding the number killed in action. High rates of suicide have also been reported for US veterans, although incidence studies in veteran populations have drawn conflicting conclusions.2
Charles W. Hoge, Carl A. Castro. Preventing Suicides in US Service Members and VeteransConcerns After a Decade of War. JAMA. 2012;308(7):671–672. doi:10.1001/jama.2012.9955