Abstract

Background: Military populations are at high risk for suicidal behavior. There are several well-known predictors for suicide and a few studies have evaluated the effect of substance abuse patterns on suicide in military environments. Objectives: This study was designed to determine substance abuse related factors that predict suicidal attempts in soldiers by concerning confounding factors. The importance of determining these risk factors is that they allow us to identify high-risk people, who should receive intensive monitoring and attempts should be made to reduce modifiable predictors. Patients and Methods: Through a cross sectional research, 3960 soldiers were selected by cluster sampling from army service garrisons in 12 regions of Iran during 2010. Data were gathered by demographic and military environment information, Texas Christian University (TCU) drug screen II and the Addiction Severity Index (ASI). The dependent variable was suicidal attempt during the military service course and the independent variables were demographic (age, education, job prior to service course and life situation), substance abuse related (the age at first substance abuse experience, alcohol abuse, tobacco abuse, ecstasy abuse, analgesics abuse, opium abuse, marijuana abuse, multi drug abuse and history of drug intoxication (subgroup analysis)), psychosocial (history of anxiety disorder, depression, obsessive compulsive disorder, personality disorder, child abuse, HIV risk behavior, physical fight) and military service-related factors (service place satisfaction, bad relationship with commanders, always having feelings of loneliness, combat situation, distance from home). Information was decoded in the SPSS 21 software and a backward logistic regression analysis was performed. Results: The majority of soldiers with mean age of 21.8 (SD = 2.4) years were single (82.1%), employed (54.5%) and had a low level of education or were illiterate (71.1%). In total, 296 (7.5%) soldiers had suicidal attempts in their military service course. Predictors of suicidal attempt were education level of under diploma, age of under 18, being abused during childhood, having a history of human immunodeficiency virus (HIV) high risk behavior, anxiety disorder, depression disorder and service place dissatisfaction. By controlling known confounders, substance abuse-related predictors of suicidal attempt were first experience of substance abuse before the age of 15 (OR = 1.48, P = 0.023), abusing opium (OR = 3.92, P = 0.000), alcohol (OR = 1.39, P = 0.023) and multi substance abuse (OR = 1.37, P = 0.029). Conclusions: By intensive monitoring of the situation of substance abuse among soldiers, commanders can reduce modifiable predictors of suicidal attempt.

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