Behavioral and social health issues and conditions of Soldiers are routinely monitored and evaluated using epidemiological techniques to report trends in all-cause mortality including suicide, as well as behavioral health such as substance abuse and dependence and psychosocial problems.
For more information, visit DCPH-A Periodic Publications and Surveillance Reports and Reports about Behavioral and Social Health in the Military.
Key findings are summarized below.
Topics and Populations
- All-cause mortality (Mortality Surveillance in the U.S. Army, 2014 – 2019)
- 5 leading causes of death in active-duty U.S. Army Soldiers, 2019:
- Suicide by Gunshot Wound
- Motor Vehicle Crashes
- Suicide by Hangings/Asphyxiations
- Neoplasms/Cancer
- Combat
- Medical non-readiness (2022 Health of the Force Report)
- In 2021, 16% of Active Component (AC) U.S. Army Soldiers were diagnosed with one or more behavioral health (BH) disorders.
- BH diagnoses impact medical non-readiness and account for the 2nd highest number of medical encounters and the highest number of hospitalized days among AC Soldiers.
- Adjustment disorders are the leading reason for BH medical visits, followed by anxiety disorder, mood disorder (for example: depression), Post Traumatic Stress Disorder (PTSD), and substance use disorder (SUD) among AC Soldiers.
- Suicidal behavior
- The suicide rate of Active Component (AC) U.S. Army Soldiers has been increasing since 2016.
- From 2014 to 2019, suicide was the leading category of death, and suicide by gunshot wound was the leading cause of death. (Mortality Surveillance in the U.S. Army, 2014 – 2019)
- Gunshot wound was the leading method of injury for Soldiers who died by suicide. (Surveillance of Suicidal Behavior: U.S. Army Active and Reserve Component Soldiers, 2019 and 2020)
- Drug and/or alcohol overdose was the primary method for attemptiong suicide. (Surveillance of Suicidal Behavior: U.S. Army Active and Reserve Component Soldiers, 2019 and 2020)
- For most years since 2010, the suicide rate among AC Soldiers has been higher than the rate in the U.S. population after adjusting for age and sex differences.
- Substance abuse and dependence (e.g., alcohol and opioids) (Surveillance of Substance Abuse and Dependence: U.S. Army Soldiers, January 2016–December 2019)
- From 2016 to 2019, a total of 672,236 medical encounters for substance abuse or dependence were documented among 38,162 Active Component U.S. Army Soldiers.
- Alcohol, cannabis, and opioids were the most frequently documented substances.
- In 2016, of the Soldiers who completed the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), 7% screened positive for hazardous drinking on the Periodic Health Assessment (PHA).
- Of the Soldiers prescribed opioids, 8% had a high-dose prescription. High-dose opioid prescriptions may increase the risk of substance misuse, addiction, overdose, or accidential death.
- Identification of high-risk populations and groups (Surveillance of Suicidal Behavior: U.S. Army Active and Reserve Component Soldiers, 2019 and 2020)
- U.S. Army Active and National Guard Soldiers 17–24 years old had the highest suicide rate compared to other age groups.
- Suicide attempts and ideation populations of concern among active and activated Reserve Soldiers are:
- Females, Soldiers (17-24 years old), and junior enlisted Soldiers (E1-E4).
- American Indian and Black active Soldiers and Black activated National Guard Soldiers.
- Medical visits for substance abuse and dependence were highest among male, junior enlisted (E1–E4), young (17–24 year old), or American Indian/Alaska Native Soldiers. (Surveillance of Substance Abuse and Dependence: U.S. Army Soldiers, January 2016-December 2019)
- Senior Non-Commissioned Officers (E7-E9), 35-65 year old, and American Indian/Alaska Native Soldiers had the highest rates of high-dose opioid prescriptions.
- Soldiers who reported symptoms of depression, and thoughts of violence or suicide were more likely to screen positive for hazardous drinking on the PHA compared to Soldiers who did not report such symptoms or thoughts.
- Behavioral health monitoring - active duty soldiers (Behavioral Health Monitoring Among Active Duty U.S. Army Soldiers, 2016-2020)
- The annual prevalence of diagnosed behavioral health disorders showed a slight, but significant downward trend, from 15% in 2017 to 13% in 2020 among male active-duty (AD) Soldiers and from 24% in 2016 to 21% in 2020 among female AD Soldiers.
- The prevalence of diagnosed BH disorders increased by 10% from the youngest to the oldest age groups (i.e., from Soldiers younger than age 25 to Soldiers age 45 or older).
- Adjustment disorders had the highest prevalence among both men and women and was responsible for the largest number of temporary profiles for behavioral health.
- Senior enlisted Soldiers had the greatest odds of behavioral health diagnosis, when compared with commissioned Officers in a model adjusted for marital status and race-ethnicity.
- Both married Soldiers and formerly married Soldiers (i.e., those who were divorced or widowed) had higher odds of behavioral health diagnosis, when compared with single Soldiers in a model adjusted for rank and race-ethnicity.
- Over the 5-year period from 2016–2020, 50% of Soldiers had at least one medical encounter for behavioral health reasons, involving either diagnosed disorders or behavioral health-related concerns such as relationship problems or work stress.
- When behavioral health affects a Soldier's readiness due to the impact on functioning, safety, or stability --and this is by no means always the case--the person may be given a profile or hospitalized. A calculation based on the number and length of behavioral health-related profiles and hospitalizations suggests that each day, during 2016–2020, 3000 Soldiers were sufficiently impaired as to be nondeployable.
- Study reporting an Association between Food Insecurity and Intimate Partner Violence (IPV) (The Association Between Food Insecurity and Intimate Partner Violence among US Army Soldiers)
- Rates of food insecurity in the military are high with reports between 25% and 33%, compared to approximately 10% among the civilian population.
- This study sought to determine if food insecurity was associated with intimate partner violence (IPV).
- In a multivariable model, marginally food insecure respondents had 2.05-fold greater adjusted odds of reporting any IPV victimization when compared to highly food secure respondents (95% confidence interval: 1.40-3.00). Marginally food insecure respondents were two-times more likely to report any IPV victimization when compared to highly food secure respondents (OR 2.05; 95% confidence interval: 1.40-3.00).
- Food insecurity can negatively impact emotional and physical health due to lack of proper nutrition.
- By addressing both food insecurity and IPV, the military has the potential to increase the overall well-being of its service members and their families.
- Study reporting an association between food insecurity and mental health
“A 2019 survey of Soldiers at a large U.S. Army installation provided 5,677 responses which gave insight into the influence of food insecurity on mental health and intentions to leave military service. (for detailed methods and findings, see the July 2021 article published in the Journal of Nutrition).
- Key findings:
- Food insecurity was defined as a lack of reliable access to sufficient, affordable, and nutritious food.
- One-third of all respondents were classified as marginally food insecure.
- Food insecurity was associated with anxiety, depression, and suicidal ideation, and, in turn, associated with intentions to leave the Army.
- The percentage of respondents who reported behavioral health conditions was as follows:
- 13.23% Suicidal Ideation;
- 17.89% Anxiety;
- 17.94% Depression.
- Intention to leave the Army, after the current term of service, was reported by approximately 52% of all respondents.
Conclusion: Enhancing food security in the military could improve mental health and subsequently, retention in service.
Department of Defense efforts: In November 2021, the DoD addressed economic security in the Force, acknowledging the challenges of Service members and families.
What DoD has done to address economic security:
The DoD continues efforts through evidence-informed actions directed to address a breadth of issues, including longer-term goals, across six lines of effort designed to:
- increase access to healthy food
- enhance spouse economic opportunities
- appraise Service member pay and benefits
- reinforce financial resources and awareness
- encourage Service members and families to seek available resources and services
- expand collection of data to improve understanding of Service member needs and challenges and report findings to inform policies and decisions to support Service members and their families.
Routine and Recurring Reporting
Routine and recurring reports are produced and examine suicidal behaviors, behavioral health, mortality and substance abuse and dependence.
- Surveillance of Suicidal Behavioral Publication (SSBP): BSHOP reports on suicides and suicide attempts among U.S. Army Active Component (AC) and Reserve Component (RC) (including Army National Guard (ARNG) and U.S. Army Reserve (USAR)).
- Mortality Surveillance: This report describes the overall characteristics of U.S. Army Soldiers who have died from January 2014 to December 2019, assesses trends in annual crude mortality rates, and compares direct age- and sex-adjusted mortality rates between the U.S. and Army populations.
- Substance Abuse and Dependence Reporting: Multiple data sources were used to identify Soldiers who 1) had at least one medical visit for substance abuse or dependence, 2) had a prescription for opioid medication, or 3) who were at high risk for hazardous drinking behavior.
- As of FY 21, the Behavioral Health Risk Assessment Data Report (BH-RADR), will be incorporated into the annual DCPH-A Health of the Force (HoF) report.
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