In the largest study of its kind, military medical researchers have concluded that deployments to war zones and exposure to combat were not major factors behind a significant increase in suicides among military personnel from 2001 to 2008, according to a paper published on Tuesday.
The study, published online by The Journal of the American Medical Association, corroborates what many military medical experts have been saying for years: that the forces underlying the spike in military suicides are similar to those in the civilian world. They include mental illness, substance abuse, and financial and relationship problems.
"The findings from this study are not consistent with the assumption that specific deployment-related characteristics, such as length of deployment, number of deployments, or combat experiences, are directly associated with increased suicide risk," the authors, based at the Naval Health Research Center in San Diego, wrote. "Instead, the risk factors associated with suicide in this military population are consistent with civilian populations, including male sex and mental disorders."
But even as it points to nondeployment factors as paramount, the study underscores the complex interplay of war and the mental health of troops, even those who never left the United States. It suggests that the stresses of 12 years of war may have worn on all service members, creating work and travel demands far outstripping those borne by peacetime troops.
"Perhaps it's not being deployed so much as being in a war during a high-stress time period," Dr. Nancy Crum-Cianflone, the principal investigator for the Millennium Cohort Study, which provided much of the raw data for the study, said in an interview.
Critics of the study said that because its analysis ended with data from 2008, it might underestimate the impact of multiple deployments and traumatic brain injuries caused by roadside bombs.
"Why would the authors repeatedly insist that there is no association between combat and suicide?" asked Dr. Stephen N. Xenakis, a psychiatrist and a retired Army brigadier general. "The careful analysis of bad data generates poor evidence."
Cynthia LeardMann, the lead author on the study, said the research team planned to update the study to include data through 2012. But she expressed confidence that its bottom line conclusions would remain the same.
"The current study includes information from when we saw a sharp increase in suicides, between 2005 and 2008," Ms. LeardMann said. "So it's demonstrating that even in that period, we don't see association with deployment."
Yet even providers of mental health care and advocates for veterans who praised the quality of the study cautioned that its findings should not be oversimplified to suggest that deployment has nothing to do with suicide.
Those providers and advocates say that deployment can prompt or intensify problems that are direct causes of suicidal behavior, including post-traumatic stress disorder, depression and substance abuse.
"I'm concerned that some might take this and say: It's not deployments. We don't need to worry about this," said Barbara Van Dahlen, a psychologist who is the founder of Give an Hour, a group that provides mental health counseling to service members and veterans. "This is telling us one important bit of the story. But there are many other factors involved."
Before the recent wars, the military suicide rate was well below the civilian rate. But the gap began narrowing shortly after 2001, a time when the civilian rate was also climbing. The sharpest increases were in the Army and the Marine Corps, the services most involved in combat operations in Iraq and Afghanistan.
In 2012, suicides among active-duty troops hit a record 350, twice as many as a decade before and more than the number of American troops killed in either combat operations or transportation accidents that year. Today, the military suicide rate is almost the same as the one for civilians, when the civilian rate is adjusted to match the high percentage of young white men in the military.
The study, which was financed by the Defense Department, used surveys conducted for the Millennium Cohort Study, which is tracking the health of thousands of service members over six decades. The researchers studied data for more than 150,000 current and former service members from all the armed services.
Using data from the National Death Index and Defense Department personnel records, the researchers found among the group 83 service members who committed suicide, of whom 58 percent had never deployed.
After correlating those suicides with data from the surveys, the researchers found that suicide rates were highest among men and among people with manic-depressive disorder, depression and alcohol problems.
The authors said their findings could point to more effective approaches to reducing suicide, citing in particular programs that focus on depression and alcohol abuse.
Craig J. Bryan, the associate director of the National Center for Veterans Studies at the University of Utah, said the study's large sample gave it added significance. "It lines up with what many of us have been finding and talking about for the last several years," he said. "But they have been able to address the limitations of previous research."
Several advocacy groups, including Iraq and Afghanistan Veterans of America and Tragedy Assistance Program for Survivors, or TAPS, also said the findings confirmed what they had been seeing on the ground.
"We so often just link military suicide to combat trauma," said Kim Ruocco, the director of postvention for TAPS. "But there are many others: long hours, separation from supports systems, sleeplessness. All are stressors. All add to increases in mental health issues."
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