Army STARRS Research Articles

Undetected suicide attempts among U.S. soldiers: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

While previous studies have reported high rates of documented suicide attempts (SAs) in the U.S. Army, the extent to which soldiers make SAs that are not identified in the healthcare system is unknown. Understanding undetected suicidal behavior is important in broadening prevention and intervention efforts. Representative survey of U.S. Regular Army enlisted soldiers (n = 24 475). Reported SAs during service were compared with SAs documented in administrative medical records. Logistic regression analyses examined sociodemographic characteristics differentiating soldiers with an undetected SA v. documented SA. Among those with an undetected SA, chi-square tests examined characteristics associated with receiving a mental health diagnosis (MH-Dx) prior to SA. Discrete-time survival analysis estimated risk of undetected SA by time in service. Prevalence of undetected SA (unweighted n = 259) was 1.3%. Annual incidence was 255.6 per 100 000 soldiers, suggesting one in three SAs are undetected. In multivariable analysis, rank ⩾E5 (OR = 3.1[95%CI 1.6-5.7]) was associated with increased odds of undetected v. documented SA. Females were more likely to have a MH-Dx prior to their undetected SA (Rao-Scott χ21 = 6.1, p = .01). Over one-fifth of undetected SAs resulted in at least moderate injury. Risk of undetected SA was greater during the first four years of service. Findings suggest that substantially more soldiers make SAs than indicated by estimates based on documented attempts. A sizable minority of undetected SAs result in significant injury. Soldiers reporting an undetected SA tend to be higher ranking than those with documented SAs. Undetected SAs require additional approaches to identifying individuals at risk.

Should I stay or should I go? The collective effects of work, family, and mental health on military career intentions among active-duty and national guard and reserve soldiers

ABSTRACT This study examined diverse predictors of military career intentions, specifically whether to stay in the military or leave, and differences based on duty status (i.e. active-duty versus National Guard or Reserve [NG/R] Service members). The combined perspectives of the personal choice model of military retention and family systems theory suggest that work factors (i.e. unit support, morale), family factors (i.e. work-family balance, romantic relationship quality), and mental health (i.e. depressive symptoms) simultaneously influence Service members’ military career intentions. Understanding how these factors together impact different dimensions of retention, namely, intentions to stay and intentions to leave, and whether they have a similar impact based on duty status are needed next steps. With data from the Army Study to Assess Risk and Resilience (Army STARRS; N = 3,506 Soldiers), path models examined the direct and indirect paths through which these factors contributed to Soldiers’ intentions to remain and intentions to leave. Then, a multigroup mediation analysis explored possible model differences based on duty status. Unit support and work-family balance directly and indirectly contributed to intentions to remain and/or leave through romantic relationship quality, depressive symptoms, and morale. Few differences emerged between active-duty and NG/R Soldiers. In sum, work factors, family factors, and depressive symptoms worked together simultaneously to explain Soldiers’ military career intentions. Military leadership, at multiple levels, is encouraged to promote supportive work environments and work-family balance. Practitioners may reinforce mental health resources to promote retention.

Uncommon Protein-Coding Variants Associated With Suicide Attempt in a Diverse Sample of U.S. Army Soldiers

BackgroundSuicide is a societal and public health concern of global scale. Identifying genetic risk factors for suicide attempt can characterize underlying biology and enable early interventions to prevent deaths. Recent studies have described common genetic variants for suicide-related behaviors. Here, we advance this search for genetic risk by analyzing the association between suicide attempt and uncommon variation exome-wide in a large, ancestrally diverse sample. MethodsWe sequenced whole genomes of 13,584 soldiers from the Army STARRS (Army Study to Assess Risk and Resilience in Servicemembers), including 979 individuals with a history of suicide attempt. Uncommon, nonsilent protein–coding variants were analyzed exome-wide for association with suicide attempt using gene-collapsed and single-variant analyses. ResultsWe identified 19 genes with variants enriched in individuals with history of suicide attempt, either through gene-collapsed or single-variant analysis (Bonferroni padjusted < .05). These genes were CIB2, MLF1, HERC1, YWHAE, RCN2, VWA5B1, ATAD3A, NACA, EP400, ZNF585A, LYST, RC3H2, PSD3, STARD9, SGMS1, ACTR6, RGS7BP, DIRAS2, and KRTAP10-1. Most genes had variants across multiple genomic ancestry groups. Seventeen of these genes were expressed in healthy brain tissue, with 9 genes expressed at the highest levels in the brain versus other tissues. Brains from individuals deceased from suicide aberrantly expressed RGS7BP (padjusted = .035) in addition to nominally significant genes including YWHAE and ACTR6, all of which have reported associations with other mental disorders. ConclusionsThese results advance the molecular characterization of suicide attempt behavior and support the utility of whole-genome sequencing for complementing the findings of genome-wide association studies in suicide research.

Understanding changes in aggression among U.S. army soldiers: The role of trauma exposure during deployment

Aggression is one of the leading concerns reported by United States service members and veterans. Trauma and posttraumatic stress disorder (PTSD) symptoms have emerged as key drivers of aggression. Research to date, however, has largely overlooked the effect of aggression on increasing risk of trauma exposure and subsequent PTSD. The current study addresses this gap by examining whether (a) pre-deployment aggression predicts trauma exposure on deployment and post-deployment PTSD, (b) trauma exposure on deployment and post-deployment PTSD predict post-deployment aggression, and (c) trauma exposure on deployment and post-deployment PTSD symptoms explain changes in aggressive behavior from pre-to post-deployment. Data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) Pre/Post Deployment Study (PPDS) on nationally representative sample of 8558 Active-duty Army soldiers were analyzed. Results revealed positive correlations between pre-deployment aggression (assessed via items from the Joint Mental Health Advisory Team 7), trauma exposure on deployment (assessed via items from the Deployment Stress Scale), post-deployment PTSD symptoms (assessed via items from the civilian PTSD Checklist and PTSD Checklist for DSM-5), and post-deployment aggression. Further, pre-deployment aggression predicted trauma exposure on deployment and post-deployment PTSD; trauma exposure on deployment and post-deployment PTSD predicted post-deployment aggression; and changes in aggression from pre-to post-deployment were partially mediated by trauma exposure on deployment and post-deployment PTSD symptoms. Collectively, these findings highlight the utility of identifying and addressing pre-deployment aggression in mitigating trauma exposure and later psychopathology.

A prospective study of marital distress and mental health symptoms across the deployment cycle.

Although recent findings imply that marital distress and mental health symptoms are intertwined among military personnel, a prospective longitudinal study is needed to evaluate the bidirectionality of the link between marital distress and mental health symptoms across the deployment cycle. We investigated over time associations using data from the Pre-Post Deployment Study component of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Married soldiers (N = 2,585) reported on their marital distress, anxiety symptoms, depressive symptoms, and posttraumatic stress disorder (PTSD) symptoms 1 month before deploying to Afghanistan and 3 months and 9 months after they returned home. The data were analyzed using cross-lagged panel models, adjusting for a variety of demographic and military covariates (including deployment stress, measured 1 month after homecoming). Results indicated (a) no associations between marital distress and mental health symptoms during the 13-month lag from predeployment to postdeployment, (b) bidirectional associations between marital distress and symptoms of anxiety and depression during the 6-month lag from 3 to 9 months after homecoming, and (c) a unidirectional association from PTSD symptoms to marital distress during the 6-month lag from 3 to 9 months after homecoming. These findings shed light on a lingering debate about the directionality of the longitudinal association between marital distress and psychopathology. They also imply points of intervention to help buffer military personnel from the harmful effects of marital distress and mental health symptoms across the deployment cycle. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

0156 Personality traits and chronicity of insomnia among soldiers

Abstract Introduction Within the behavioral model of insomnia, predisposing factors can increase vulnerability to developing problems sleep. One predisposing factor is personality characteristics and past research has identified associations between traits such as rumination/worry and perfectionism with insomnia. Past studies have not considered the chronicity of insomnia and its association with personality characteristics. The goal of this study was to examine the association between chronicity of insomnia and a wide range of personality traits to identify a risk profile for chronic sleep disturbance. Methods Data were acquired from the New Soldier Study(NSS) components of the Army Study to Assess Risk and Resilience in Service members(Army STARRS), which collected survey data from soldiers newly recruited to the military(N=38,348; 20.9 (3.5) years old; 82.8% male). The data captures information regarding soldiers sleep, personal characteristics and mental health symptoms. Participants reported on lifetime history of insomnia with a frequency of at least 3 nights/week as well as the number of years they have experienced insomnia. Items also assessed a range of personality traits. A stepwise selection model was used to identify a profile of personality traits associated with chronicity of insomnia. Results Lifetime history of insomnia was very high at 88.7%, with a mean(SD) duration of insomnia mean (SD)=3.0(2.4) years. The selection model identified three personality traits significantly associated with duration of insomnia: feeling empty inside, the need to rely more heavily on friends for emotional support, and being scared of things most people are (all p&amp;lt; 0.05). Conclusion These results demonstrate that, among new Army soldiers, those who have experienced chronic problems with insomnia endorse feeling empty inside leading to them stating either they are not scared of most things (increase in risk taking) or need to rely heavily on others for emotional support. Consistent with previous research, these data suggest that emotional instability is linked to poorer sleep quality. Support (if any) This publication is based on public use data from Army STARRS(Inter-university Consortium for Political and Social Research, University of Michigan-http://doi.org/10.3886/ICPSR35197-v1), funded by U.S. NIMH-U01MH087981. KEM’s time was supported by the U.S Department of Veterans Affairs, Veterans Health Administration (Clinical Science Research and Development Service – IK2 CX001874).

0413 Neuroticism interacts with stressful experiences during deployment to predict post-deployment insomnia

Abstract Introduction Negative affect traits, such as neuroticism, have been shown to be associated with greater risk for insomnia. These trait-based factors are theorized to increase stress reactivity, which can be a predisposing factor to insomnia. Military personnel represent a unique population that are subject to stressors as a nature of their occupations and may therefore be particularly vulnerable to the onset and persistence of insomnia. The present study examined prospective associations among trait-based emotional reactivity and neuroticism, exposure to stressful experiences during a combat deployment, and insomnia symptoms at 9-months post-deployment. Methods Data were obtained from the Army Study to Assess Risk and Resilience in Servicemembers Pre-Post Deployment Survey (PPDS). Soldiers included in these analyses (n = 1448) completed surveys prior to deployment to Afghanistan, immediately after deployment, and 9-month post-deployment. The survey included measures of insomnia symptoms, deployment-related stressors and trait-based personality measures. Logistic regression was used to examine the relationships among emotional reactivity, neuroticism and deployment stress with post-deployment insomnia. Results Higher trait-based neuroticism and greater exposure to deployment-related stressors were independently associated with greater risk of probable insomnia at 9-months post-deployment, but not trait-based emotional reactivity . However, there were significant interaction effects, such that among those with greater range of stressful events, neuroticism was associated with higher risk of post-deployment insomnia, while emotional reactivity was associated with lower risk. Conclusion A trait disposition for negative affect (i.e., neuroticism) may predispose individuals to chronic insomnia in the face of acute stressors . While neuroticism includes negative emotional reactivity, it also encompasses other characteristics (e.g., negative self-perception) that may be a stronger predictor of persistent insomnia symptoms. Service members with higher baseline neuroticism may benefit from pre-deployment skills trainings to better cope in the face of stressors and prevent/mitigate long-term problems. Support (if any) This study is based on public use data from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan-http://doi.org/10.3886/ICPSR35197-v1), funded by U.S. NIMH-U01MH087981.

0298 Romantic Relationships and Insomnia in Military Soldiers

Abstract Introduction Intimate relationships may impact insomnia symptoms. In particular, marriage may serve as a protective factor against the development of insomnia, particularly for men. However, little research has studied how relationship quality may contribute to insomnia, particularly in military populations where social support may be particularly important. Therefore, this study will examine the associations between indices of relationship quality and insomnia in a sample of Army Soldiers. Methods Data were acquired from the All Army Study of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS; N=21,449; mean age= 28.6; 88.24% male). Participants completed a survey that included questions about insomnia symptoms and their social networks. Items assessed marital status, duration of marriage, frequency of disagreements, and relationship quality and happiness. Chi-squared analyses were used to examine the associations between probable insomnia from the past 30 days and relationship items. Results Approximately 38.2% of this sample experienced past month insomnia symptoms. Insomnia was more prevalent in divorced or separated individuals. Among partnered individuals, Soldiers who reported that they talked more about ending the relationship and had more disagreements with their partners were more likely to have insomnia symptoms. Conversely, those reporting that their relationships were going well or satisfied in their relationship were more likely to not have insomnia. Conclusion In this sample of Soldiers, marriage only served as a protective factor when individuals had a positive outlook in their relationship. These results also suggest that healthier relationships are generally associated with better sleep. These findings underline the importance of relationship quality and its effects on insomnia. Support (if any) This publication is based on public use data from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan-http://doi.org/10.3886/ICPSR35197-v1), funded by U.S. NIMH-U01MH087981. CJS’s time was supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship in Mental Illness Research and Treatment. KEM’s time was supported by the U.S Department of Veterans Affairs, Veterans Health Administration (Clinical Science Research and Development Service – IK2 CX001874).

Genetic, environmental, and behavioral correlates of lifetime suicide attempt: Analysis of additive and interactive effects in two cohorts of US Army soldiers

Recently developed measures of genetic liability to suicide attempt may convey unique information regarding an individual’s risk of suicidal behavior. We calculated a polygenic risk score for suicide attempt (SA-PRS) for soldiers of European ancestry who participated in the Army STARRS New Soldier Study (NSS; n = 6573) or Pre/Post Deployment Study (PPDS; n = 4900). Multivariable logistic regression models were fit within each sample to estimate the association of SA-PRS with lifetime suicide attempt (LSA), and to examine whether SA-PRS displayed additive or interactive effects with environmental and behavioral risk/protective factors (lifetime trauma burden, childhood maltreatment, negative urgency impulsivity, social network size, perceived mattering, and dispositional optimism). Age, sex, and within-ancestry variation were included as covariates. Observed prevalence of LSA was 6.3% and 4.2% in the NSS and PPDS samples, respectively. In the NSS model, SA-PRS and environmental/behavioral factors displayed strictly additive effects on odds of LSA. Results indicated an estimated 21% increase in odds of LSA per 1 SD increase in SA-PRS [adjusted odds ratio (AOR; 95% CI) = 1.21 (1.09–1.35)]. In PPDS, the effect of SA-PRS varied by reports of optimism [AOR = 0.85 (0.74–0.98) for SA-PRS x optimism effect]. Individuals reporting low and average optimism had 37% and 16% increased odds of LSA per 1 SD increase in SA-PRS, respectively, whereas SA-PRS was not associated with LSA in those reporting high optimism. Overall, results suggested the SA-PRS had predictive value over and above several environmental and behavioral risk factors for LSA. Moreover, elevated SA-PRS may be more concerning in the presence of environmental and behavioral risk factors (e.g., high trauma burden; low optimism). Given the relatively small effect magnitudes, the cost and incremental benefits of utilizing SA-PRS for risk targeting must also be considered in future work.

Traumatic brain injury and relationship distress during military deployment and reunion

AbstractObjectiveThis study seeks to advance the literature by disentangling the effects of deployment‐acquired traumatic brain injury (TBI) from comorbid postconcussive symptoms and PTSD symptoms on relationship distress.BackgroundBecause TBI poses challenges to military marriages, understanding the predictors of relationship distress after TBI is important for helping service members cope with the effects of the injury.MethodSurvey data from the U.S. Army STARRS Pre–Post Deployment Study, collected from 2,585 married service members before and after a combat deployment to Afghanistan, evaluated predictors of relationship distress 9 months after homecoming.ResultsDeployment‐acquired TBI corresponded with more relationship distress controlling for predeployment brain health, but its predictive power was eclipsed by concurrent postconcussive symptoms and concurrent PTSD symptoms. Concurrent PTSD symptoms accounted for twice as much variance in relationship distress than concurrent postconcussive symptoms.ConclusionTargeting and treating comorbid conditions may be essential for supporting military marriages after TBI.Implications: Military command, policymakers, and medical professionals may find value in broadening support services for TBI to include resources addressing postconcussive symptoms, PTSD symptoms, and relationship distress.

Exposure to Bullying or Hazing During Deployment and Mental Health Outcomes Among US Army Soldiers

Workplace bullying is associated with mental disorders and suicidality in civilians, but few studies have examined associations of bullying with these outcomes among military personnel. To evaluate associations of being bullied or hazed during deployment with major depressive disorder (MDD), intermittent explosive disorder, posttraumatic stress disorder (PTSD), suicidal ideation, and substance use disorder (SUD). This cohort study used data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) New Soldier Study (NSS; April 1, 2011, to November 30, 2012) and wave 1 of the STARRS Longitudinal Study (STARRS-LS1; September 1, 2016, to April 30, 2018). A computerized survey administered at 3 US Army installations (NSS) and a web/telephone survey (STARRS-LS1) were used to collect data. Data were analyzed from October 11, 2021, to October 28, 2022. The STARRS-LS1 recruited a probability sample of active-duty soldiers and veterans who had participated in Army STARRS baseline surveys while on active duty (weighted response rate, 35.6%). Respondents whose baseline was the NSS and who had deployed to a combat theater at least once were eligible for this study. Being bullied or hazed during a combat deployment. The primary outcomes were MDD, intermittent explosive disorder, PTSD, and suicidal ideation in the 12 months before STARRS-LS1 and SUD in the 30 days before STARRS-LS1, assessed with items from the Composite International Diagnostic Interview Screening Scales, PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and Columbia-Suicide Severity Rating Scale. Logistic regression was used to estimate associations of bullying or hazing exposure with the outcomes. The 1463 participants were predominantly male (weighted percentage [SE], 90.4% [0.9%]) and had a mean (SE) age of 21.1 (0.1) years at baseline. At STARRS-LS1, 188 respondents (weighted percentage [SE], 12.2% [1.1%]) reported bullying or hazing during deployment. Weighted outcome prevalences were 18.7% (1.3%) for MDD, 5.2% (0.9%) for intermittent explosive disorder, 21.8% (1.5%) for PTSD, 14.2% (1.2%) for suicidal ideation, and 8.7% (1.0%) for SUD. In models that adjusted for baseline sociodemographic and clinical characteristics and other potential traumas, exposure to bullying or hazing 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), PTSD (aOR, 1.86; 95% CI, 1.23-2.83), suicidal ideation (aOR, 1.91; 95% CI, 1.17-3.13), and SUD (aOR, 2.06; 95% CI, 1.15-3.70). In this cohort study of combat-deployed soldiers, reports of being bullied or hazed during deployment were associated with mental disorders and suicidal thoughts. Recognition of these associations may inform efforts to prevent and address mental health problems among service members.

Recent Stressful Experiences and Suicide Risk: Implications for Suicide Prevention and Intervention in U.S. Army Soldiers.

To identify the extent to which the presence of recent stressful events are risk factors for suicide among active-duty soldiers as reported by informants. Next-of-kin (NOK) and supervisors (SUP) of active duty soldiers (n=135) who died by suicide and two groups of living controls: propensity-matched (n=128) and soldiers who reported suicidal ideation in the past year, but did not die (SI) (n=108) provided data via structured interviews from the Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Multivariate logistic regression analyses were used to create a risk score for suicide. The odds of suicide increased significantly for soldiers experiencing relationship problems, military punishment, and perceived failure or humiliation in the month prior to death. Suicide risk models with these risk factors predicted suicide death among those who reported SI in the past year (OR=5.9, [95% CI = 1.5, 24.0] χ 2=6.24, p=0.0125, AUC, 0.73 (0.7, 0.8) NOK) and (OR=8.6, [95% CI = 1.4, 51.5] χ 2=5.49, p=0.0191, AUC, 0.78 (0.7, 0.8); SUP) suggesting the combination of these recent stressors may contribute to the transition from ideation to action. Our findings suggest for the first time recent stressors distinguished suicide ideating controls from suicide decedents in the month prior to death as reported by informants. Implications for preventive intervention efforts for clinicians, supervisors and family members in identifying the transition from ideation to action are discussed.

Resilience in Army STARRS: Evaluating psychometrics of a multi-dimensional resilience measure

ABSTRACT As policymakers and the U.S. military continue to place an emphasis on the resilience of servicemembers, it is critical to utilize psychometrically sound and valid scales to measure resilience. Using two independent samples of Army soldiers-in-training, this study explored the measurement of resilience in the Army Study to Assess Risk and Resilience among Servicemembers (Army STARRS) New Soldier Study Component (NSS). Exploratory factor analysis (EFA) was used to identify the factor structure of a measure of resilience within the Army STARRS NSS. Confirmatory factor analysis (CFA) was then used to confirm the factor structure, then internal reliability was assessed. Convergent validity of the identified resilience factors was examined using two-tailed bivariate correlations. The EFA identified a three-factor structure of a measure of resilience. The CFA confirm the first-order three-factor structure of stress tolerance, positive orientation, and social resources. Each factor was uniquely distinct from measures of the likelihood of generalized anxiety disorder and major depressive disorder, lifetime stressful events, and social network. Findings highlights the utility of a three-factor aggregate measure of resilience in the Army STARRS NSS and provide practitioners with a more nuanced picture of the role of resilience among soldiers-in-training.

0434 The Relationship between Spirituality and Insomnia in Military Soldiers

Abstract Introduction Insomnia is prevalent among military soldiers and contributes to poor physical and mental health outcomes. Spirituality has been found to mitigate mental and physical health complaints; however, there is a dearth of research on its relationship with insomnia, particularly among military soldiers. Therefore, this study examined the associations between spirituality, religiosity, and insomnia in a sample of Army soldiers. Methods Data were acquired from the All Army Study of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS; N=21,449; mean age= 28.6; 88.24% male). Participants completed the Brief Insomnia Questionnaire, and current insomnia status was determined by DSM-5 criteria. They also completed questions on religious affiliation, how often they attend religious services, and how religious or spiritual they consider themselves on a 4-point scale (1-Very to 4-Not at all). Chi-Square analyses were used to assess the magnitude of relationships. Results A total of 19.45% of this sample had insomnia. Self-reported religious affiliation was more common in those without insomnia (73.5%) than those with insomnia (69.9%; p&amp;lt;.0001). Self-reported spirituality and religiosity were associated with lower rates of insomnia (p&amp;lt;.0001; p&amp;lt;.0001). However, insomnia was associated with higher rates of regular attendance of religious services (29.8% vs. 26.0%; p&amp;lt;.0001). Conclusion In this sample of Army servicemembers, insomnia was less prevalent among those with a religious affiliation and those with regular attendance at religious services. In contrast, individuals with insomnia reported themselves to be less religious or spiritual compared to those without insomnia. These findings underline the importance of further research to understand whether spirituality provides any protective effects against insomnia. Support (If Any) This publication is based on public use data from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan-http://doi.org/10.3886/ICPSR35197-v1), funded by U.S. NIMH-U01MH087981. KEM’s time was supported by the U.S Department of Veterans Affairs, Veterans Health Administration (Clinical Science Research and Development Service – IK2 CX001874). EAK’s time was supported by the U.S Department of Veterans Affairs, Rehabilitation Research and Development Service – 1IK2 RX001836.

0438 The Impact of Unit Cohesion on Insomnia Symptoms among Army Soldiers

Abstract Introduction Sleep disturbance is common in military personnel and is often related to stressful conditions and deployment to a warzone. Among soldiers, the achievement of unit goals and performance is often dependent upon how cohesive members of the unit are. The quality of unit experiences in terms of reliance on other unit members, feeling respected, and interpersonal relationships could impact the ability to sleep at night. The primary hypothesis of this analysis was that poorer quality unit experiences would be associated with worse sleep at night. Methods Data were acquired from the All Army Study of the Army Study to Assess Risk and Resilience in Service members (STARRS; N= 21,449; 28.65 {SD=7.45} years old; 88.24% male). Participants completed the Brief Insomnia Questionnaire, and current insomnia status was determined by DSM-5 criteria. They also completed survey items related to how much respect they had for their officers and other members of their unit as well as how much respect they received in return, their overall morale and if they felt they could rely on members of their unit. T-tests and Chi-square tests were used to examine the associations between insomnia and unit experiences. Results More negative feelings about unit cohesiveness was associated with higher rates of insomnia (t(19401)= -41.19, p&amp;lt;.0001). Similarly, greater feelings of not being respected by other unit members was associated with higher rates of insomnia (X2 (3, N=19275) = 869.9, p&amp;lt;.0001). Strongly believing that the job reward was not worth the effort that was put into their work also had a significant increase in disturbed sleep (X2 (4, N=19214) = 1120.5, p&amp;lt;.0001). Conclusion These results demonstrate that, among Army soldiers, poorer quality experiences with other unit members are related to higher rates of insomnia symptoms. Service members who felt they could not rely on other members of their unit, did not feel their officers respected them, and could not speak openly to officers endorsed strong feelings regarding how cohesive their unit was and ultimately reported poorer sleep. Support (If Any) This publication is based on public use data from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan-http://doi.org/10.3886/ICPSR35197-v1), funded by U.S. NIMH-U01MH087981. KEM’s time was supported by the U.S Department of Veterans Affairs, Veterans Health Administration (Clinical Science Research and Development Service – IK2 CX001874). EAK’s time was supported by the U.S Department of Veterans Affairs, Rehabilitation Research and Development Service – 1IK2 RX001836.

0691 Examining the Associations between Insomnia and Adult-ADHD Diagnosis in Army Soldiers

Abstract Introduction Most research on the association between insomnia and attention deficit hyperactivity disorder (ADHD) has been conducted in children. It has been established that insomnia and ADHD are frequently comorbid, but less is known about whether the association extends to individual ADHD symptoms, or any possible moderators of the association. This study aims to understand whether sex plays a key role in the moderation between insomnia and ADHD in adult military servicemembers, as well as to investigate the relationship between insomnia diagnosis and ADHD symptomology. Methods Data were obtained from the All Army Study of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS; N=21292; age 18-61, 88.24% male). Participants completed a survey that included items assessing insomnia and ADHD status based on DSM-5 criteria. Chi-squares and logistic regression, including interactions with sex, were used to examine the relationship between insomnia diagnosis and ADHD symptomology. Results There is a significant association between insomnia and ADHD diagnoses (r = 0.30; &amp;lt;.0001), consistent with prior literature. There was a small but statistically significant moderation by sex of the relationship between insomnia and ADHD diagnosis (Chi square = 9.43; p = .002). There was also a strong association between insomnia diagnosis and certain symptoms of ADHD: keeping attention on repetitive work (Chi square = 3687.75; &amp;lt;.0001), remembering appointments (Chi square = 3186.735; &amp;lt;.0001), and getting things in order (Chi square = 2756.28; &amp;lt;.0001). Conclusion Insomnia diagnosis was associated with both ADHD diagnosis and symptomology in a nationwide sample of army servicemembers, with the relationships being stronger in males compared to females. These findings highlight the importance of assessment and treatment of insomnia in patients with ADHD given their interrelationships. Support (If Any) This publication is based on data obtained from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan-http://doi.org/10.3886/ICPSR35197-v1). KEM’s time was supported by the U.S. Department of Veterans Affairs, Clinical Science Research and Development Service - IK2 CX001874. EAK’s time was supported by the U.S. Department of Veterans Affairs, Rehabilitation Research and Development Service-1IK2 RX001836.

Attachment Style and Risk of Suicide Attempt Among New Soldiers in the U.S. Army

Objective Among U.S. Army soldiers suicide attempts (SAs) are a significant public health concern, particularly early in service. We examined the association of attachment style with SA and suicide ideation (SI) among U.S. Army soldiers. Methods We analyzed survey data from new soldiers who participated in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). The sample consists of 38,507 soldiers entering Basic Combat Training (BCT) between April 2011 and November 2012. Attachment style (secure, preoccupied, fearful, and dismissing) was assessed using items from the Relationship Questionnaire. Lifetime (pre-enlistment) SA and SI were assessed with a modified Columbia Suicide Severity Rating Scale. Logistic regression analyses examined associations of attachment style with lifetime SA, SI, and attempts among ideators, after adjusting for socio-demographic characteristics. Results The secure attachment style was associated with lower odds of SA (OR = 0.76, 95% CI = 0.63–0.92), whereas preoccupied (OR = 4.63, 95% CI = 3.83–5.61), fearful (OR = 4.08, 95% CI = 3.38–4.94), or dismissing (OR = 1.56, 95% CI = 1.24–1.96) attachment styles were associated with higher odds of SA. Similar results were found for SI. Importantly, both preoccupied (OR = 1.67, 95% CI = 1.37–2.04) and fearful (OR = 1.70, 95% CI = 1.38–2.08) attachment were associated with attempts among ideators. Conclusion These findings highlight the clinical importance of attachment style in predicting suicidal behavior and as possible targets for intervention. A critical next step is for prospective research to examine whether attachment style predicts future suicidal behavior.

Pre-enlistment Anger Attacks and Postenlistment Mental Disorders and Suicidality Among US Army Soldiers

Anger is linked to adverse outcomes in military populations; however, whether pre-enlistment anger attacks are associated with postenlistment mental disorders and suicidality is unknown. To explore the associations of pre-enlistment anger attacks with postenlistment mental health. In this observational cohort study, the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) New Soldier Study (NSS) surveyed soldiers entering basic training from April 2011 to November 2012, with a subsample recruited for wave 1 of the STARRS Longitudinal Study (STARRS-LS) (conducted September 2016 to April 2018). Participants were recruited from 3 US Army installations for the NSS survey. Those who were subsequently contacted for STARRS-LS completed the follow-up survey via web or telephone. Prospective analyses were based on a weighted NSS subsample included in wave 1 of STARRS-LS. Data were analyzed from May 22, 2020, to March 17, 2021. History of anger attacks at baseline (NSS). Survey responses were used to classify new soldiers as having nonimpairing anger attacks (>2 attacks without interference in work or personal life), impairing anger attacks (>2 attacks with interference in work or personal life), or no significant history of anger attacks. Baseline analyses examined sociodemographic and clinical correlates of a history of anger attacks. Prospective logistic regression models estimated associations of baseline history of anger attacks with new onset and persistence of posttraumatic stress disorder, major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder, mania/hypomania, substance use disorder, suicidal ideation, and suicide attempt at wave 1 of STARRS-LS. Of the 38 507 baseline participants (83.0% male and 17.0% female; mean [SD] age, 20.97 [3.57] years), 6216 were selected for and completed wave 1 of the STARRS-LS. Baseline prevalence (SE) of nonimpairing and impairing anger attacks was 8.83% (0.16%) and 5.75% (0.15%), respectively. Prospective models showed that impairing anger attacks were associated with new onset of MDD (adjusted odds ratio [AOR], 1.98; 95% CI, 1.31-2.99), GAD (AOR, 2.39; 95% CI, 1.66-3.45), panic disorder (AOR, 2.02; 95% CI, 1.34-3.05), and suicidal ideation (AOR, 2.11; 95% CI, 1.45-3.07). When baseline psychiatric comorbidity was controlled for, impairing attacks remained associated with onset of GAD (AOR, 1.75; 95% CI, 1.19-2.58) and suicidal ideation (AOR, 1.62; 95% CI, 1.09-2.42). Anger attacks were not significantly associated with persistence of pre-enlistment mental disorders. The findings of this study suggest that a pre-enlistment history of impairing anger attacks may be associated with elevated risk of developing GAD, MDD, and suicidality after enlistment. Detection of impairing anger attacks could aid in assessing psychiatric risk in new soldiers.

Army STARRS Study Finds Risks to Progression From Suicidal Ideation to Attempts

Army STARRS Study Finds Risks to Progression From Suicidal Ideation to Attempts

Parental suicide attempt and subsequent risk of pre-enlistment suicide attempt among male and female new soldiers in the U.S. Army.

Suicide and suicide attempts among U.S. Army soldiers are a significant concern for public health. This study examined the association of parental suicide attempt prior to age 13 of the soldier with subsequent risk of pre-enlistment suicide attempt. We conducted secondary analyses of survey data from new soldiers who participated in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) (N=38,396). A series of logistic regression analyses were conducted. Of all new soldiers, 1.4% reported that they attempted suicide between age 13 and entering the Army, and 2.3% reported a parental suicide attempt prior to age 13. Parental suicide attempt was associated with increased odds of subsequent suicide attempt; however, this association was moderated by gender and was significant only among male soldiers. The association between parental suicide attempt and pre-enlistment suicide attempt among male soldiers was still significant after controlling for socio-demographic characteristics, soldier/parental psychopathology, and childhood adversities. These results highlight parental suicide attempt as a unique pre-enlistment risk factor for suicide attempt, especially among male new soldiers. Further studies are needed to separate the genetic and environmental contributions to intra-familial risk for suicidal behavior.