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Story highlights

A suicide attempt in an Army unit is linked to higher risk for other soldiers in that unit, a new study finds

When it comes to military suicides, "there is a crisis on our hands," one veteran says

(CNN) —  

Marc Raciti had the tree picked out.

Positioned on a rolling Hawaiian hillside along the North Shore in Oahu, where the now-retired United States Army major was stationed, that tree was where Raciti said he planned to take his last breath. He planned to hang himself.

As a physician assistant, Raciti had been deployed five times, twice to Iraq, and mourned the suicide deaths of three medics who served with him. He suffered post-traumatic stress disorder and often fantasized about suicide.

“I did lose three medics after coming back from Iraq to suicide, which exasperated my PTSD, but mine is of survivor’s guilt for the ones I could not save,” Raciti said.

The US Department of Defense has continued to investigate what factors might influence a military member’s risk of suicide attempt, and a new study suggests that previous suicide attempts in a particular unit of members can play a significant role.

Within Army units, the risk of suicide attempts among soldiers increases as the number of attempts made within the past year in their unit rises, according to the study, published in the journal JAMA Psychiatry on Wednesday.

In other words, the greater the number of previous suicide attempts in a unit, the greater the individual risk of a suicide attempt for a soldier in that unit, said Dr. Robert Ursano, professor of psychiatry and neuroscience and director of the Center for the Study of Traumatic Stress at the Department of Defense’s Uniformed Services University.

“Historically, you were protected from suicide when you went in the Army. Rates of suicide were about half of those in the civilian population, and around 2009, they increased to above that of the civilian population and they remained high since then,” said Ursano, who was lead author of the new study.

Now, about 20% of suicide deaths in the United States each year are military veterans, according to the Military Health System.

“This is an important part of trying to understand that story,” Ursano said about the new study. “Although we often talk about the clustering of suicides and suicide attempts, it’s rarely been able to be examined in an empirical way, using actual data.”

The aftermath of a suicide attempt

The study involved data on 9,512 enlisted soldiers who attempted suicide between 2004 and 2009, documented in administrative and medical records.

The data came from the Army’s Study to Assess Risk and Resilience in Servicemembers research project, or STARRS, the nation’s largest study of mental health risk and resilience among military personnel.

After analyzing the data, the researchers found that soldiers were more likely to attempt suicide if assigned to a unit with one or more previous suicide attempts in the past year, and that risk increased as the number of previous suicide attempts went up.

Among combat arms and other occupations, the risk of suicide attempt was about twice as likely among those in units with at least five previous suicide attempts in the past year versus units with none, the researchers found.

The risk for a unit with at least one suicide attempt in the past year was 18.2%, “indicating that, if the risk associated with units that had at least one past-year significant attempt could be reduced to those with no attempts, 18.2% of attempts would not occur,” the researchers wrote in the study.

That increased risk remained significant even after adjusting for each soldier’s sociodemographic factors, age, time in service, deployment status, occupation, and unit size, although the findings were particularly pronounced in smaller units, the researchers found.

“It actually aligns with some research that’s been published in the past few years using smaller samples that aren’t necessarily representative of the Army, but have similarly found that exposure to suicide is associated with increased risk of suicidal thoughts and behaviors in other service members,” said Craig Bryan, a psychology professor and executive director of the National Center for Veterans Studies at the University of Utah, who was not involved in the new study.

The US Department of Veterans Affairs offers a crisis help line, local suicide prevention coordinators, and other resources to the general public.

However, Bryan said that the new study could help in developing improved approaches for what’s known as postvention efforts – an organized response after a suicide or suicide attempt – specifically when a suicide attempt occurs in an Army unit.