UH Hilo research team coauthors comprehensive historical study of suicide in U.S. Army

Pink logo for JAMA Network Open TM.The study, published Dec. 13 in JAMA Network Open, challenges the assumption that combat is the primary driver of suicide in active duty U.S. Army forces.

By Leah Sherwood.

The largest historical study to date of suicide in the U.S. Army was published Dec. 13 in the Journal of the American Medical Association (JAMA) Network Open. The comprehensive study coauthored by a team of researchers from the University of Hawai‘i at Hilo challenges the assumption that combat is the primary driver of suicide in active duty U.S. Army forces.

Jeff Smith wearing glasses and smiling at the camera.
Jeffrey Smith

The authors compared suicide rates among active duty U.S. Army service members from the 19th century to the 21st century, and from that data were able to extrapolate historical trends in suicide rates. They found that historically, suicides decreased during times of war, but not during the wars in Afghanistan, Iraq, and Vietnam.

“This was a historic study of active duty U.S. Army suicide and what it appears to show is that the usual understanding of basically combat as the primary driver of suicide, seems to be incorrect, at least from a historical standpoint,” says Jeffrey Smith, lead author and associate professor and chair of the history department at UH Hilo.

“For the most part during active war time, you actually saw a pattern of decreases in suicide rates, and that seems to be historically true across the 19th and first half of the 20th century,” says Smith. “However, that paradigm seems to change once you get to the so-called ‘endless’ wars in Vietnam, Iraq, and Afghanistan. Those conflicts look to represent a new paradigm shift as you are seeing increases in suicide during wartime.”

The study is titled, “A Historical Examination of Military Records of U.S. Army Suicide, 1819 to 2017.” Smith’s coauthors are Michael Doidge, historian with the Department of Defense’s Defense Health Agency; Ryan Hanoa, a senior majoring in history at UH Hilo; and B. Christopher Frueh, a clinical psychologist and professor of psychology at UH Hilo.

Bartley Christopher Frueh wearing glasses and looking at the camera.
B. Christopher Frueh

Frueh and Smith have been collaborating with each other since 2011 and published a 2012 study that estimated rates of suicide, alcohol abuse, and probable psychiatric illness among Union Forces during the U.S. Civil War by looking at data compiled by the Union Army. For the current study, Frueh provided expertise on the medical background and psychological aspects of the study.

“Chris is coming at it from the psychological, practitioner side,” explains Smith. “He interpreted this data from the standpoint of somebody who is currently treating both active duty service members and veterans. We would compare theories and data, what I was finding historically to what he was seeing presently.”

History major and coauthor Hanoa was born and raised on Hawai‘i Island and is a veteran of the U.S. Navy. He will be graduating this month and as a student of Smith’s assisted on the project with research and data organization and visualization. Smith and Frueh acknowledged Hanoa’s contributions and historical research acumen by making Hanoa a coauthor, an impressive achievement for an undergraduate research assistant.

Smith hopes the study will lead to analyzing other factors outside of combat to understand what is driving the current increase in active-duty military and veteran suicide rates.

“The study appears to show that researchers should possibly be looking for causes away from the battlefield,” says Smith. “We are coming at it from a standpoint that this a medical issue that is probably multifactorial, and related to socioeconomic and psychological issues more so than combat exposure.”

He says the next phase of the research will compare suicide rates and trends in civilian and veteran data.

“What we are hoping to do is open up some new lines of inquiry and start considering new avenues for how to address this that are beyond what is often times associated singularly with combat,” says Smith. “After all, you cannot understand a problem unless you understand the history of it.”


Story by Leah Sherwood, a graduate student in the tropical conservation biology and environmental science program at UH Hilo. She received her bachelor of science in biology and bachelor of arts in English from Boise State University. 

Photo of Jeff Smith by Raiatea Arcuri, a professional photographer majoring in business administration with a concentration in finance at UH Hilo. 

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