Intentional injury victims and perpetrators in the U.S. Army: Is a college education the answer?

Education is associated with reduced risk for intentional injuries. It is not clear whether the effect is direct or indirect (e.g., education is related to income and other factors). Clarifying the circumstances under which education is protective may illuminate important mediators and effect modifiers in the causal pathway and thereby improve intervention effectiveness. We identified 89,833 individuals who experienced suicide, non-fatal self-inflicted injury hospitalization, homicide, non-fatal assault-related hospitalization, spouse abuse victimization, spouse abuse perpetration or child abuse perpetration and matched them to 157,592 controls who did not experience any of these events. All subjects were on active duty in the U.S. Army between 1971 and 2005. Logistic regression models were used to investigate the associations between demographic characteristics and prior hospitalization for each of the intentional injury outcomes with control as the referent category. Effect modifiers of the association between college education and outcome were identified with second-order interactions between education and other factors (e.g., gender by education). In the main effects model, college education was protective against all adverse outcomes. However, in models with interactions, the extent of the reduction in risk was modified by demographic factors. For most outcomes modeled, college education was protective for men but less so for women. The protective effect of education was also attenuated by prior mental health disorder. Age, rank, time in service, race and risk-taking also interact with college education. Education may be an important modifiable risk factor but the protective effects vary by demographic groups and by intentional injury type.