Bullying by Fellow US Army Soldiers Associated With Mental Disorders and Suicide

Bullying or hazing by fellow US Army soldiers during deployment is common and associated with mental disorders and suicidal ideation, according to investigators’ findings published in the Journal of the American Medical Association Network Open.

Investigators sought to assess associations for US Army soldiers bullied by fellow soldiers with mental health outcomes. Primary endpoints were posttraumatic stress disorder (PTSD), major depressive disorder (MDD), suicidal ideation, substance use disorder (SUD), and intermittent explosive disorder. They hypothesized that bullying during deployment would be independently associated with mental health outcomes.

Investigators conducted a retrospective cohort study using data from studies conducted by the US Army (the Army Study to Assess Risk and Resilience in Servicemembers [Army STARRS], New Soldier Study [NSS; April 2011 through November 2012], and wave 1 of the STARRS Longitudinal Study [STARRS-LS1; September 2016 through April 2018]).

The Army used a computerized survey administered at 3 US Army installations for the NSS, and they used a web/telephone survey to collect data for the STARRS-LS1. A probability sample of active-duty soldiers and veterans who had participated in Army STARRS baseline surveys on active duty were recruited for the STARRS-LS1. Eligibility included deployment to a combat theater at least once. They noted 38,507 soldiers in the NSS, of whom 6216 completed the STARRS-LS1 survey. Among these soldiers, 1467 reported deployment to a combat theater, 4 of whom lacked bullying data.

Investigators found among the 1463 participants (weighted percentage 90.4% [standard error {SE} 0.9%] men; mean age at baseline 21.1 years; 58.1% White, 18.3% Hispanic, 16.2% Black) there were 188 respondents who reported bullying during deployment. Weighted outcome prevalence was 21.8% (SE 1.5%) PTSD; 18.7% (1.3%) MDD; 14.2% (1.2%) suicidal ideation; 8.7% (1.0%) SUD; 5.2% (0.9%) intermittent explosive disorder.

Those who reported bullying during deployment were disproportionately women, younger, more likely to have reported other deployment and nondeployment stressors, more likely to have reported lifetime PTSD and suicidal ideation at baseline.

Investigators noted bullying was significantly associated with:

• MDD (adjusted odds ratio [aOR], 2.92; 95% CI, 1.74-4.88);
• Intermittent explosive disorder (aOR, 2.59; 95% CI, 1.20-5.59);
• SUD (aOR, 2.06; 95% CI, 1.15-3.70);
• Suicidal ideation (aOR, 1.91; 95% CI, 1.17-3.13) and;
• PTSD (aOR, 1.86; 95% CI, 1.23-2.83)

in models that adjusted for baseline clinical and sociodemographic characteristics and additional potential traumas.

Trauma exposure variables used for logistic regression analysis included a combat exposure score, binary variables capturing physical assault (while deployed or not), sexual assault (while deployed or not), other life-threatening events (outside deployment), exposure to details of traumas that happened to other people (outside deployment), and serious injury or death of a loved one (outside deployment).

Study limitations include the inability to make causal inferences as mental health conditions may have predated bullying, the retrospective design, recall bias, mood-congruent reporting biases, definitions of bullying not provided to respondents, and self-reports of bullying were not validated.

Additional limitations include respondents failing to report bullying events because they were unrecognized as such, no assessment of the nature of bullying, no assessment of the frequency of bullying, and mental health issues not captured by the STARRS-LS1 survey.  

Investigators noted a substantial proportion of deployed soldiers (1 in 8) reported having been bullied. They concluded that among combat-deployed US Army soldiers “reports of being bullied or hazed during deployment were associated with mental disorders and suicidal ideation at follow-up.” Investigators wrote, “These associations remained significant after adjusting for baseline characteristics and other potential traumas during the follow-up period.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor