'Unprecedented' NIMH study looks at military suicide prevention

The U.S. Army has enlisted the National Institute of Mental Health (NIMH) to try and mitigate suicides among the troops.

The study has been called "unprecedented" by officials at NIMH.

Study director Dr. Robert Heinssen said those involved are relying on the three "R's" -- rigorous study, rapid execution, and relevant targets -- to find answers.

He talked more about it on Thursday's Daily Debrief and said four institutions are working together with a "sense of urgency" to determine the cause of the high rates and how to prevent future deaths.

"The Army reached out to NIMH last summer and asked us if we were aware of any research-based approaches that had been developed on the civilian side that would help the Army with the problem of a rising suicide rate."

According to NIMH, suicide is the fourth leading cause of death among 25 to 44-year-olds in the United States.

Historically, the agency said, 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 rate in the civilian population.

The Army turned to NIMH for answers.

Dr. Heinssen explained that his agency found that the Army was operating according to the best principles that had been developed on the civilian side.

This prompted the Army to ask NIMH to develop a research strategy that would help to better explain the circumstances surrounding an increasing rate of suicide.

Thus, a Memorandum of Agreement was signed in October, 2008, to sponsor a study that would look for risk factors for suicide among the troops.

"This is the first time, at least for NIMH, that we've partnered actively with the Army in a project that is designed to bring the best science to bear on a public health problem within the Army -- and to use the science as a means of identifying improved ways of intervening to mitigate the problem."

Dr. Heinssen said NIMH's approach is epidemiological: it will look for both risk and protective factors that are related to mental disorders and suicides among both active duty and retired soldiers.

"The study is designed to identify risk and protective factors that may not have been uncovered by other types of strategy. So, we're going to rely on the fact that we're going to survey large numbers of individuals. We'll follow specific groups over time and we think that this strategy will be successful in identifying risk factors that may not currently be recognized because they may have a weak relationship to both mental disorder and suicide on an individual basis, but that, over time, these weakly-linked risk factors may aggregate."

Dr. Heinssen is confident that there will not be one single determinate in any case.

He hypothesized that there will be many factors involved that interact with the experiences of a soldier, such as training and combat.

"Certain of those risk and protective factors may be modifiable, such that we can address them early in the process so that the longer term risk for mental health problems and suicide is really diminished."

The study officially started on July 16, 2009, though NIMH and the Army started collaborating months beforehand.

"NIMH and the Army have been collaborating . . . to identify data sets that already exist within the Army that might be integrated in a way that hasn't been done up until now. [We are working] to pull together variables that, presumably, could inform our understanding of risks and outcomes."

This initial collaboration was done in the hopes of speeding up the work of the academic investiagtors once they became part of the study.

Since July, four institutions have been working with NIMH on the study.

According to NIMH, doctors from the Uniformed Services University of the Health Sciences, the University of Michigan at Ann Arbor, Harvard Medical School and Columbia University are all involved.

Dr. Heinssen said everyone involved is working under a sense of urgency. He added that the Army has made it crystal clear that they want the work done sooner rather than later.

"They [are] interested in applying the best scientific tools and methods to understand this problem in a way that would generate practical solutions in a way that they could implement to [solve] the problem. . . . When we put out our request for applications, we needed to challenge [academia] to propose ways which they would rapidly and rigourously evaluate information that they were gathering, and interpret its meaning during the course of the project."

This meant that academia had to propose novel strategies for getting the work done.

Dr. Heinssen said that, normally, mental health studies are performed in three phases: analyzing data, interpreting it and then reporting the results.

"[We told them] they would have to demonstrate the ability to have a nimble scientific approach so that, if they discovered something that was unexpected during the course of the study, they would be able to re-orient their research enterprise to study that unexpected finding in detail. . . . So this really is an unprecedented approach. It's definetly not business as usual and, in a sense, it's kind of an experiment for us and a different way of promoting and managing science."

Dr. Heinssen said the critical nature of the study and the potential impact of the findings drive him to want to do his job to the best of his abilities.

"It's humbling. It's sobering -- but it also gives you a sense of mission. This is an incredibly important enterprise and it deserves the best energy, creativity and effort from all of us involved. . . . If we do it well, lives will be saved."

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On the Web:

NIMH -- Evidence-Based Prevention is Goal of Largest Ever Study of Suicide in the Military

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