In Reply We would like to thank Ruan et al for their interest in our article1 and address their criticism. Citing evidence that chronic pain (1) increases the risk for suicidal outcomes and (2) is a prevalent condition among active-duty soldiers and veterans, Ruan et al state that we “missed an important and likely link to suicide attempts in the military” by not controlling for physical pain in all of our analyses. Although we agree that chronic pain is a potentially important predictor of suicide risk,2 it is only one of many additional variables (eg, legal problems, financial problems, relationship breakups, sexual assault, and exposure to others’ suicide) that have been shown to be associated with suicidal outcomes and with risk factors for suicidal outcomes, such as depression.3-5
Ursano RJ, Kessler RC, Stein MB. Suicide Attempts Among US Army Soldiers—Reply. JAMA Psychiatry. 2017;74(1):106–107. doi:10.1001/jamapsychiatry.2016.2746
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