Nonfatal Suicidal Behaviors in U.S. Army Administrative Records, 2004–2009: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

Ursano, Robert J.; Kessler, Ronald C.; Heeringa, Steven G.; Cox, Kenneth L.; Naifeh, James A.; Fullerton, Carol S.; Sampson, Nancy A.; Kao, Tzu‐Cheg; Aliaga, Pablo A.; Vegella, Patti; Mash, Holly Herberman; Buckley, Christina E.; Colpe, Lisa J.; Schoenbaum, Michael; Stein, Murray B.

doi:10.1080/00332747.2015.1006512

Cited by 58 publications

(73 citation statements)

References 41 publications

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“… 12 Combining the 2 definitions is justified by analyses reported elsewhere showing that they have very similar correlates. 12 Soldiers who died by suicide but without a prior nonfatal SA were excluded from analysis based on evidence in previous research that the risk factors for suicide death are different from the risk factors for nonfatal SA. 8 …”

Section: Methodsmentioning

confidence: 99%

Assessment of a Risk Index for Suicide Attempts Among US Army Soldiers With Suicide Ideation

et al. 2019

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Key Points Question Is a short self-report battery associated with improved assessment of risk for suicide attempt among soldiers with suicide ideation? Findings This cohort study of 3649 soldiers participating in the Army Study to Assess Risk and Resilience in Servicemembers survey found that a cross-validated model including self-reported history and severity of suicidal thoughts and behaviors, positive screens for mental disorders, and Army career characteristics was associated with administratively reported suicide attempts 18 to 45 months following baseline among respondents with lifetime suicide ideation at baseline. The 10% of those with suicide ideation who had the highest estimated risk accounted for 39.2% of subsequent suicide attempts. Meaning It may be feasible to develop a clinical risk index for suicide attempt given suicide ideation from a small number of self-report questions.

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Section: Methodsmentioning

confidence: 99%

Assessment of a Risk Index for Suicide Attempts Among US Army Soldiers With Suicide Ideation

et al. 2019

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“…Prior to selection, the population of control person-months was stratified by gender, rank, time in service, deployment status (never deployed, currently deployed, or previously deployed), and historical time. The control sample excluded all person-months in which a soldier died or had an administratively documented non-fatal suicidal event (e.g., suicide attempt, suicide ideation) [3]. To adjust for under-sampling, control person-months were weighted to 200.…”

Section: Methodsmentioning

confidence: 99%

“…Cross-referencing of the different data systems was conducted to ensure that all cases represented unique soldiers. When multiple suicide attempts were documented for a single soldier, a hierarchical classification scheme was used to select the first attempt [3]. Administrative records were also used to construct variables for socio-demographic characteristics (gender, age at entry into Army service, current age, race, education, and marital status), active time in service (based on the number of months an RC soldier was activated), deployment status (never deployed, currently deployed, or previously deployed), and previous mental health diagnosis (Additional file 1: Table S1).…”

Section: Methodsmentioning

confidence: 99%

“…The SREs assume other predictors in the final model are at their sample-wide means. A dummy predictor for calendar month and year was included in all logistic regression equations to control for secular trends in suicidal behaviors during the study period [1–3, 9, 32]. Among enlisted soldiers (the number of officer cases was insufficient), changes in suicide attempt risk across active time in service were further examined in a discrete-time survival model that estimated risk (suicide attempters per 100,000 person-months) in each active month since entering the Army.…”

Section: Methodsmentioning

confidence: 99%

“…Rates of non-fatal suicide attempts and suicide deaths among U.S. Army soldiers increased during the wars in Iraq and Afghanistan [1–3], with elevated risk persisting among veterans who have left the military [4, 5]. Most research on non-fatal suicide attempts has focused on the full-time soldiers within the Army’s Active Component (AC) (e.g., [6–8]).…”

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confidence: 99%

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Suicide attempts among activated soldiers in the U.S. Army reserve components

et al. 2019

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BackgroundAlthough the majority of active duty U.S. Army soldiers are full-time personnel in the Active Component (AC), a substantial minority of soldiers on active duty are in the Reserve Components (RCs). These “citizen-soldiers” (Army National Guard and Army Reserve) represent a force available for rapid activation in times of national need. RC soldiers experience many of the same stressors as AC soldiers as well as stressors that are unique to their intermittent service. Despite the important role of RC soldiers, the vast majority of military mental health research focuses on AC soldiers. One important goal of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is to address this gap. Here we examine predictors of suicide attempts among activated RC soldiers.MethodsThis longitudinal, retrospective cohort study used individual-level person-month records from Army and Department of Defense administrative data systems to examine socio-demographic, service-related, and mental health predictors of medically documented suicide attempts among activated RC soldiers during 2004–2009. Data from all 1103 activated RC suicide attempters and an equal-probability sample of 69,867 control person-months were analyzed using a discrete-time survival framework.ResultsEnlisted soldiers comprised 84.3% of activated RC soldiers and accounted for 95.7% of all activated RC suicide attempts (overall rate = 108/100,000 person-years, more than four times the rate among officers). Multivariable predictors of enlisted RC suicide attempts included being female, entering Army service at age ≥ 25, current age < 30, non-Hispanic white, less than high school education, currently married, having 1–2 years of service, being previously deployed (vs. currently deployed), and history of mental health diagnosis (particularly when documented in the previous month). Predictors among RC officers (overall rate = 26/100,000 person-years) included being female and receiving a mental health diagnosis in the previous month. Discrete-time hazard models showed suicide attempt risk among enlisted soldiers was inversely associated with time in service.ConclusionsRisk factors for suicide attempt in the RCs were similar to those previously observed in the AC, highlighting the importance of research and prevention focused on RC enlisted soldiers in the early phases of Army service and those with a recent mental health diagnosis.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1978-2) contains supplementary material, which is available to authorized users.

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Factors Associated With Suicide Ideation in US Army Soldiers During Deployment in Afghanistan

et al. 2020

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IMPORTANCE Understanding suicide ideation (SI) during combat deployment can inform prevention and treatment during and after deployment. OBJECTIVE To examine associations of sociodemographic characteristics, lifetime and past-year stressors, and mental disorders with 30-day SI among a representative sample of US Army soldiers deployed in Afghanistan. DESIGN, SETTING, AND PARTICIPANTS In this survey study, soldiers deployed to Afghanistan completed self-administered questionnaires in July 2012. The sample was weighted to represent all 87 032 soldiers serving in Afghanistan. Prevalence of lifetime, past-year, and 30-day SI and mental disorders was determined. Logistic regression analyses examined risk factors associated with SI. Data analyses for this study were conducted between August 2018 and August 2019. MAIN OUTCOMES AND MEASURES Suicide ideation, lifetime and 12-month stressors, and mental disorders were assessed with questionnaires. Administrative records identified sociodemographic characteristics and suicide attempts. RESULTS A total of 3957 soldiers (3473 [weighted 87.5%] male; 2135 [weighted 52.6%] aged Յ29 years) completed self-administered questionnaires during their deployment in Afghanistan. Lifetime, past-year, and 30-day SI prevalence estimates were 11.7%, 3.0%, and 1.9%, respectively. Among soldiers with SI, 44.2% had major depressive disorder (MDD) and 19.3% had posttraumatic stress disorder in the past 30-day period. A series of analyses of the 23 grouped variables potentially associated with SI resulted in a final model of sex; race/ethnicity; lifetime noncombat trauma; past 12-month relationship problems, legal problems, and death or illness of a friend or family member; and MDD. In this final multivariable model, white race/ethnicity (odds ratio [OR], 3.1 [95% CI, 1.8-5.1]), lifetime noncombat trauma (OR, 2.1 [95% CI, 1.1-4.0]), and MDD (past 30 days: OR, 31.8 [95% CI, 15.0-67.7]; before past 30 days: OR, 4.9 [95% CI, 2.5-9.6]) were associated with SI. Among the 85 soldiers with past 30-day SI, from survey administration through 12 months after returning from deployment, 6% (5 participants) had a documented suicide attempt vs 0.14% (6 participants) of the 3872 soldiers without SI. CONCLUSIONS AND RELEVANCE This study suggests that major depressive disorder and noncombat trauma are important factors in identifying SI risk during combat deployment.

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Nonfatal Suicidal Behaviors in U.S. Army Administrative Records, 2004–2009: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

Cited by 58 publications

References 41 publications

Assessment of a Risk Index for Suicide Attempts Among US Army Soldiers With Suicide Ideation

Assessment of a Risk Index for Suicide Attempts Among US Army Soldiers With Suicide Ideation

Suicide attempts among activated soldiers in the U.S. Army reserve components

Factors Associated With Suicide Ideation in US Army Soldiers During Deployment in Afghanistan

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