Resilience In Servicemembers Research Articles

Supplemental Material for Patterns and Predictors of Persistence of Suicide Ideation: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

Supplemental Material for Patterns and Predictors of Persistence of Suicide Ideation: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

Prevalence, predictors and correlates of insomnia in US army soldiers.

The objective of this study was to investigate the rates, predictors and correlates of insomnia in a national sample of US Army soldiers. Data were gathered from the cross-sectional survey responses of the All-Army Study, of the Army Study to Assess Risk and Resilience in Service members. Participants were a representative sample of 21 499 US Army soldiers who responded to the All-Army Study self-administered questionnaire between 2011 and 2013. Insomnia was defined by selected DSM-5 criteria using the Brief Insomnia Questionnaire. The results highlight significant functional difficulties associated with insomnia among US soldiers, as well as insights into predictors of insomnia specific to this population. Insomnia was present in 22.76% of the sample. Predictors of insomnia status in logistic regression included greater number of current mental health disorders, less perceived open lines of communication with leadership, less unit member support and less education. Insomnia had global, negative associations with health, social functioning, support, morale, work performance and Army career intentions. The results provide the strongest evidence to-date that insomnia is common in a military population, and is associated with a wide array of negative factors in the domains of health, military readiness and intentions to remain in military careers.

Documented family violence and risk of suicide attempt among U.S. Army soldiers

Suicide attempt (SA) rates in the U.S. Army increased substantially during the wars in Afghanistan and Iraq. This study examined associations of family violence (FV) history with SA risk among soldiers. Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), we identified person-month records of active duty, Regular Army, enlisted soldiers with medically documented SAs from 2004 to 2009 (n = 9650) and a sample of control person-months (n = 153,528). Logistic regression analyses examined associations of FV with SA, adjusting for socio-demographics, service-related characteristics, and prior mental health diagnosis. Odds of SA were higher in soldiers with a FV history and increased as the number of FV events increased. Soldiers experiencing past-month FV were almost five times as likely to attempt suicide as those with no FV history. Odds of SA were elevated for both perpetrators and those who were exclusively victims. Male perpetrators had higher odds of SA than male victims, whereas female perpetrators and female victims did not differ in SA risk. A discrete-time hazard function indicated that SA risk was highest in the initial months following the first FV event. FV is an important consideration in understanding risk of SA among soldiers.

Prior Mental Disorders and Lifetime Suicidal Behaviors Among US Army Soldiers in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

We report on associations of retrospectively reported temporally prior mental disorders and Army career characteristics with subsequent first onset of suicidal behaviors in a large, representative sample of US Army soldiers who participated in the Consolidated All-Army Survey of the Army Study to Assess Risk and Resilience in Servicemembers (N=29,982). Results reveal that among men and women, all self-reported lifetime disorders measured (some assessed with screening scales) are associated with subsequent onset of suicide ideation. Among men, three disorders characterized by agitation and impulsiveness (intermittent explosive disorder, panic disorder, and substance disorders) predict the transition from suicide ideation to attempt. For both men and women, being in the Regular Army (vs. National Guard or Army Reserve) predicts suicide attempts in the total sample. For men, a history of deployment and junior rank are predictors of suicide attempts after adjusting for preenlistment disorders but not accounting for pre- and postenlistment disorders, suggesting that postenlistment disorders account for some of the increased suicide risk among these career characteristics. Overall, these results highlight associations between mental disorders and suicidal behaviors, but underscore limitations predicting which people with ideation attempt suicide.

Suicide Attempts Linked to Previous Attempts in Soldiers’ Unit, Says Army Study

Back to table of contents Previous article Next article Professional NewsFull AccessSuicide Attempts Linked to Previous Attempts in Soldiers’ Unit, Says Army StudyAaron LevinAaron LevinSearch for more papers by this authorPublished Online:14 Sep 2017https://doi.org/10.1176/appi.pn.2017.9b10AbstractRates of suicide attempts in the U.S. Army from 2004 to 2009 were associated as much with the environment as a soldier’s own circumstances.The latest report from a long-term study of suicidality in the U.S. Army indicates that a prior-year history of suicide attempts in an Army unit was associated with an increased risk of such attempts by other soldiers in that unit. The findings, published online on July 26 in JAMA Psychiatry, indicate that units with a history of suicide attempts may be important targets for preventive interventions.“Early unit-based postvention consisting of coordinated efforts to provide behavioral, psychosocial, spiritual, and public health support after suicide attempts may be an essential tool in promoting recovery and suicide prevention in servicemembers,” wrote the researchers.Researchers for the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) used Army administrative data from 2004 through 2009 to compare records of 9,512 enlisted personnel who attempted suicide with 151,526 control person-months. Robert Ursano, M.D., notes that one factor that might influence the occurrence of multiple suicides in a unit is stress from deployment or change in command.“We saw substantially higher odds ratios across unit sizes and across different military occupational specialties,” said lead author Robert Ursano, M.D., a professor of psychiatry and neuroscience and director of the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences in Bethesda, Md.The study found that soldiers were more likely to attempt suicide if at least one other soldier in the unit had attempted suicide. The risk rose as attempts increased within a unit. Soldiers in units that experienced five or more attempts in the prior year were 2.3 times more likely to attempt suicide than those in units with no attempts, said the authors. Suicide attempts were significantly associated with a prior mental health diagnosis, but not with suicide deaths, combat, unintentional injury, or Army occupation category. Suicide attempts occurring in smaller units (one to 40 soldiers) were also linked with increased risk. “Unit characteristics that persist over time, including leadership quality, extent of social support and cohesion, and presence of bullying, may influence unit culture and affect the likelihood of and responses to unit [suicide attempts],” said the authors.“This paper is extremely elegant and adds methodologically to the field in its consideration of the environment and unit size,” said retired Brig. Gen. Stephen Xenakis, a former Army psychiatrist, in an interview. “Command climate is so important in small units composed of young people, so the critical person is the squad leader, who leads perhaps a dozen soldiers.”Xenakis, who was not involved with the study, raised the as-yet-unsettled issue of contagion—the idea that a suicide attempt in one’s unit gives “permission” to consider a situation so intractable that ending one’s life is the only answer. However, Ursano cautioned that other factors may play a significant role as well.“Just because we can identify clusters of suicide attempts within a unit, we should not necessarily conclude that the mechanism connecting them is ‘contagion,’ ” said Ursano in an interview. “It could be a unit under high stress, whether from operations, deployment, or a change of command.”The study focused on the period 2004 to 2009, before the Army took steps to address the high rates of suicide, said Xenakis. Beginning in 2010, the service assigned behavioral health specialists to combat units where they could get to know soldiers and talk with them on a routine basis. They could then identify individuals with serious mental health problems and refer them to more experienced clinical help when needed.Another study, called Army STARRS Longitudintal Study (STARRS-LS), will gather data from 2010 to 2015 and is in the early stages of developing suicide prevention strategies integrating behavioral, psychosocial, spiritual, and public health support.“The findings themselves are a reminder of the importance of community to mental health,” said Ursano. “It’s good to be reminded that communities, families, and neighbors form a substantial part of both protecting one’s mental health as well as potentially increasing the risk to one’s mental health.” ■“Risk of Suicide Attempt Among Soldiers in Army Units With a History of Suicide Attempts” can be accessed here. A related editorial, “Suicidal Behaviors Within Army Units: Contagion and Implications for Public Health Interventions,” is available here. ISSUES NewArchived

Risk of Suicide Attempt Among Soldiers in Army Units With a History of Suicide Attempts

Mental health of soldiers is adversely affected by the death and injury of other unit members, but whether risk of suicide attempt is influenced by previous suicide attempts in a soldier's unit is unknown. To examine whether a soldier's risk of suicide attempt is influenced by previous suicide attempts in that soldier's unit. Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers (STARRS), this study identified person-month records for all active-duty, regular US Army, enlisted soldiers who attempted suicide from January 1, 2004, through December 31, 2009 (n = 9650), and an equal-probability sample of control person-months (n = 153 528). Data analysis was performed from August 8, 2016, to April 10, 2017. Logistic regression analyses examined the number of past-year suicide attempts in a soldier's unit as a predictor of subsequent suicide attempt, controlling for sociodemographic features, service-related characteristics, prior mental health diagnosis, and other unit variables, including suicide-, combat-, and unintentional injury-related unit deaths. The study also examined whether the influence of previous unit suicide attempts varied by military occupational specialty (MOS) and unit size. Of the final analytic sample of 9512 enlisted soldiers who attempted suicide and 151 526 control person-months, most were male (86.4%), 29 years or younger (68.4%), younger than 21 years when entering the army (62.2%), white (59.8%), high school educated (76.6%), and currently married (54.8%). In adjusted models, soldiers were more likely to attempt suicide if 1 or more suicide attempts occurred in their unit during the past year (odds ratios [ORs], 1.4-2.3; P < .001), with odds increasing as the number of unit attempts increased. The odds of suicide attempt among soldiers in a unit with 5 or more past-year attempts was more than twice that of soldiers in a unit with no previous attempts (OR, 2.3; 95% CI, 2.1-2.6). The association of previous unit suicide attempts with subsequent risk was significant whether soldiers had a combat arms MOS or other MOS (ORs, 1.4-2.3; P < .001) and regardless of unit size, with the highest risk among those in smaller units (1-40 soldiers) (ORs, 2.1-5.9; P < .001). The population-attributable risk proportion for 1 or more unit suicide attempts in the past year indicated that, if this risk could be reduced to no unit attempts, 18.2% of attempts would not occur. Risk of suicide attempt among soldiers increased as the number of past-year suicide attempts within their unit increased for combat arms and other MOSs and for units of any size but particularly for smaller units. Units with a history of suicide attempts may be important targets for preventive interventions.

Knowledge mapping visualization analysis of the military health and medicine papers published in the web of science over the past 10\xa0years

BackgroundMilitary medicine is a research field that seeks to solve the medical problems that occur in modern war conditions based on public medicine theory.MethodsWe explore the main research topics of military health and medical research in the web of science™ core collection (WoSCC) from 2007 to 2016, and the goal of this work is to serve as a reference for orientation and development in military health and medicine. Based on CiteSpace III, a reference co-citation analysis is performed for 7921 papers published in the WoSCC from 2007 to 2016. In addition, a cluster analysis of research topics is performed with a comprehensive analysis of high-yield authors, outstanding research institutions and their cooperative networks.ResultsCurrently, the research topics in military health and medicine mainly focus on the following seven aspects: mental health diagnoses and interventions, an army study to assess risk and resilience in service members (STARRS), large-scale military action, brain science, veterans, soldier parents and children of wartime, and wound infection. We also observed that the annual publication rate increased with time. Wessely S, Greenberg N, Fear NT, Smith TC, Smith B, Jones N, Ryan MAK, Boyko EJ, Hull L, and Rona RJ were the top 10 authors in military health and medicine research. The top 10 institutes were the Uniformed Services University of the Health Sciences, the United States Army, the United States Navy, Kings College London, Walter Reed National Military Medical Center, Boston University, Walter Reed Army Institute of Research, Walter Reed Army Medical Center, Naval Health Research Center, and the VA Boston Healthcare System.ConclusionsWe are able to perform a comprehensive analysis of studies in military health and medicine research and summarize the current research climate and the developmental trends in the WoSCC. However, further studies and collaborations are needed worldwide. Overall, our findings provide valuable information and new perspectives and shape future research directions for further research in the area of military health and medicine.

Lifetime Suicidal Behaviors and Career Characteristics Among U.S. Army Soldiers: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

The current report presents data on lifetime prevalence of suicide ideation and nonfatal attempts as reported by the large representative sample of U.S. Army soldiers who participated in the Consolidated All-Army Survey of the Army Study to Assess Risk and Resilience in Servicemembers (N=29,982). We also examine associations of key Army career characteristics with these outcomes. Prevalence estimates for lifetime suicide ideation are 12.7% among men and 20.1% among women, and for lifetime suicide attempts are 2.5% and 5.1%, respectively. Retrospective age-of-onset reports suggest that 53.4%-70% of these outcomes had preenlistment onsets. Results revealed that, for both men and women, being in the Regular Army, compared with being in the National Guard or Army Reserve, and being in an enlisted rank, compared with being an officer, is associated with increased risk of suicidal behaviors and that this elevated risk is present both before and after joining the Army.

Psychiatric disorders moderate the relationship between insomnia and cognitive problems in military soldiers

BackgroundThere has been a great deal of research on the comorbidity of insomnia and psychiatric disorders, but much of the existing data is based on small samples and does not assess the full diagnostic criteria for each disorder. Further, the exact nature of the relationship between these conditions and their impact on cognitive problems are under-researched in military samples. MethodData were collected from the All Army Study of the Army Study to Assess Risk and Resilience in Service members (unweighted N = 21, 449; weighted N = 674,335; 18–61 years; 13.5% female). Participants completed the Brief Insomnia Questionnaire to assess for insomnia disorder and a self-administered version of the Composite International Diagnostic Interview Screening Scales to assess for psychiatric disorders and cognitive problems. ResultsMilitary soldiers with current major depressive episode (MDE) had the highest prevalence of insomnia disorder (INS; 85.0%), followed by current generalized anxiety disorder (GAD; 82.6%) and current posttraumatic stress disorder (PTSD; 69.7%), respectively. Significant interactions were found between insomnia and psychiatric disorders; specifically, MDE, PTSD, and GAD status influenced the relationship between insomnia and memory/concentration problems. Limitations: Cross-sectional nature of the assessment and the absence of a comprehensive neurocognitive battery. ConclusionPsychiatric disorders moderated the relationship between insomnia and memory/concentration problems, suggesting that psychiatric disorders contribute unique variance to cognitive problems even though they are associated with insomnia disorder. Results highlight the importance of considering both insomnia and psychiatric disorders in the diagnosis and treatment of cognitive deficits in military soldiers.

Suicide attempts in U.S. Army combat arms, special forces and combat medics

BackgroundThe U.S. Army suicide attempt rate increased sharply during the wars in Iraq and Afghanistan. Risk may vary according to occupation, which significantly influences the stressors that soldiers experience.MethodsUsing administrative data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), we identified person-month records for all active duty Regular Army enlisted soldiers who had a medically documented suicide attempt from 2004 through 2009 (n = 9650) and an equal-probability sample of control person-months (n = 153,528). Logistic regression analyses examined the association of combat occupation (combat arms [CA], special forces [SF], combat medic [CM]) with suicide attempt, adjusting for socio-demographics, service-related characteristics, and prior mental health diagnosis.ResultsIn adjusted models, the odds of attempting suicide were higher in CA (OR = 1.2 [95% CI: 1.1–1.2]) and CM (OR = 1.4 [95% CI: 1.3–1.5]), but lower in SF (OR = 0.3 [95% CI: 0.2–0.5]) compared to all other occupations. CA and CM had higher odds of suicide attempt than other occupations if never deployed (ORs = 1.1–1.5) or previously deployed (ORs = 1.2–1.3), but not when currently deployed. Occupation was associated with suicide attempt in the first ten years of service, but not beyond. In the first year of service, primarily a time of training, CM had higher odds of suicide attempt than both CA (OR = 1.4 [95% CI: 1.2–1.6]) and other occupations (OR = 1.5 [95% CI: 1.3–1.7]). Discrete-time hazard functions revealed that these occupations had distinct patterns of monthly risk during the first year of service.ConclusionsMilitary occupation can inform the understanding suicide attempt risk among soldiers.

Childhood Maltreatment and Lifetime Suicidal Behaviors Among New Soldiers in the US Army: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

Understanding suicide risk is a priority for the US military. We aimed to estimate associations of childhood maltreatment with pre-enlistment suicidal behaviors in new Army soldiers. Cross-sectional survey data from 38,237 soldiers reporting for basic training from April 2011 through November 2012 were analyzed. Scales assessing retrospectively reported childhood abuse and neglect were derived and subjected to latent class analysis, which yielded 5 profiles: No Maltreatment, Episodic Emotional Maltreatment, Frequent Emotional/Physical Maltreatment, Episodic Emotional/Sexual Abuse, and Frequent Emotional/Physical/Sexual Maltreatment. Discrete-time survival analysis was used to estimate associations of maltreatment profiles with suicidal behaviors (assessed with a modified Columbia-Suicide Severity Rating Scale), adjusting for sociodemographics and mental disorders. Nearly 1 in 5 new soldiers was classified as experiencing childhood maltreatment. Relative to No Maltreatment, all multivariate maltreatment profiles were associated (P values < .001) with elevated odds of lifetime suicidal ideation (adjusted odds ratios [AORs] = 3.10-4.93), plan (AORs = 3.75-10.77), attempt (AORs = 3.60-15.95), and onset of plan among those with ideation (AORs = 1.40-3.10). Several profiles also predicted attempts among those with plans (AORs = 2.01-2.47), and Frequent Emotional/Physical/Sexual Maltreatment predicted unplanned attempts among ideators (AOR = 5.32). Adjustment for mental disorders attenuated but did not eliminate these associations. Childhood maltreatment is strongly associated with suicidal behavior among new soldiers, even after adjusting for intervening mental disorders. Among soldiers with lifetime ideation, certain maltreatment profiles are associated with elevated odds of subsequently planning and/or attempting suicide. Focus on childhood maltreatment might reveal avenues for risk reduction among new soldiers.

Psychological autopsy study comparing suicide decedents, suicide ideators, and propensity score matched controls: results from the study to assess risk and resilience in service members (Army STARRS).

The suicide rate has increased significantly among US Army soldiers over the past decade. Here we report the first results from a large psychological autopsy study using two control groups designed to reveal risk factors for suicide death among soldiers beyond known sociodemographic factors and the presence of suicide ideation. Informants were next-of-kin and Army supervisors for: 135 suicide cases, 137 control soldiers propensity-score-matched on known sociodemographic risk factors for suicide and Army history variables, and 118 control soldiers who reported suicide ideation in the past year. Results revealed that most (79.3%) soldiers who died by suicide have a prior mental disorder; mental disorders in the prior 30-days were especially strong risk factors for suicide death. Approximately half of suicide decedents tell someone that they are considering suicide. Virtually all of the risk factors identified in this study differed between suicide cases and propensity-score-matched controls, but did not significantly differ between suicide cases and suicide ideators. The most striking difference between suicides and ideators was the presence in the former of an internalizing disorder (especially depression) and multi-morbidity (i.e. 3+ disorders) in the past 30 days. Most soldiers who die by suicide have identifiable mental disorders shortly before their death and tell others about their suicidal thinking, suggesting that there are opportunities for prevention and intervention. However, few risk factors distinguish between suicide ideators and decedents, pointing to an important direction for future research.

1102 THE RELATIONSHIP BETWEEN SLEEP DISTURBANCE, NEGATIVE AFFECT, AND EMOTION REGULATION

Although sleep disturbance is often anecdotally associated with increased negative affect, there has been relatively little research that has directly examined this relationship, in either healthy or depressed populations. Therefore, this study aimed to examine the relationship between sleep disturbance, negative affect, including anger and irritability, and emotion regulation in a sample of healthy (HC) and depressed (MDD) active service members of the US Army. Data for this study came from the survey of the All-Army Study (AAS), a component of the Army Study to Assess Risk and Resilience in Service Members (Army STARRS), a representative sample of active duty Army personnel (N=19,506). Diagnosis of MDD was based on the Composite International Diagnostic Interview Screening Scales. Sleep disturbance was coded as absent or present utilizing one survey item. One item was also used to assess frequency of irritability, while composite scores were created and used to assess both frequency of anger and the frequency of utilizing healthy emotion regulation strategies (i.e., “Try new approaches if old ones don’t work”). Results from Multivariate ANOVA revealed a significant sleep disturbance by group (HC, MDD) interaction for irritability, F(1,19502) = 7.437, p<.01, and emotion regulation, F(1,19502) = 4.282, p<.05, but not anger. Post-hoc tests revealed that having sleep disturbance was associated with more irritability and anger, and poorer emotion regulation in healthy controls, however this pattern did not hold for those with MDD. In MDD, sleep disturbance was associated with increased anger, but was not associated with differences in emotion regulation skills. Irritability was associated with sleep disturbance, but to a lesser extent than in HC. The results of this study support the anecdotal evidence that sleep disturbance is associated with greater negative affect in addition to lower utilization of healthy emotion regulation strategies. However, these findings were only true of healthy controls. In those with MDD, increases in sleep disturbance may not play as pivotal a role in increasing emotional dysregulation. None

0422 EVALUATING THE ASSOCIATION BETWEEN INSOMNIA SUBTYPES AND SUICIDAL IDEATION AMONG ARMY SERVICEMEMBERS

Past studies support an association between insomnia and suicidal ideation. Few studies, however, have parsed insomnia into its respective subtypes (i.e., early, middle, and late insomnia), to assess if one of the subtypes confers more risk for suicidal ideation than the others. To assess this possibility, the present study assessed associations between suicidal ideation (globally construed) and early, middle, and late insomnia, as well as the phenomenon of frequent awakenings. The sample consisted of 2,617 servicemembers that participated in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), a large epidemiological study examining the risk factors for suicidality. Insomnia variables included measures of early, middle, and late insomnia and frequent nocturnal awakenings. Depression was determined by whether or not the participant met criteria for a depressive episode during the past 30 days. Suicidal ideation was determined by whether or not participants endorsed any form of suicidal ideation during the same time frame. To determine the independent effect of each insomnia variable on suicidal ideation, a stepwise logistic regression was conducted. Insomnia and depression variables were entered as independent variables in the model, and suicidal ideation was entered as the dependent variable. When controlling for depression [OR = 7.05, p < .001], only early insomnia [OR = 1.13, p = .02] and frequent awakenings [OR = 1.23, p < .001] emerged as significant predictors of suicidal ideation. The present data provide some insight into the specific nature of the relationship between insomnia and suicidal ideation, in that early insomnia (i.e., difficulty initiating sleep) and frequent awakenings were distinctly associated with a global measure of suicidal ideation. If these results are found to be reliable (over subsequent studies with similar and/or different populations and/or using prospective measures) such data may serve to focus future investigations on how insomnia confers risk for suicidality. Army STARRS was funded by the US Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health (NIH/NIMH; U01MH087981).

Health care contact and suicide risk documentation prior to suicide death: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

Prior research has shown that a substantial portion of suicide decedents access health care in the weeks and months before their death. We examined whether this is true among soldiers. The sample included the 569 Regular Army soldiers in the U.S. Army who died by suicide on active duty between 2004 and 2009 compared to 5,690 matched controls. Analyses examined the prevalence and frequency of health care contacts and documentation of suicide risk (i.e., the presence of prior suicidal thoughts and behaviors) over the year preceding suicide death. Predictors of health care contact and suicide risk documentation were also examined. Approximately 50% of suicide decedents accessed health care in the month prior to their death, and over 25% of suicide decedents accessed health care in the week prior to their death. Mental health encounters were significantly more prevalent among suicide decedents (4 weeks: 27.9% vs. 7.9%, χ2 = 96.2, p < .001; 52 weeks: 59.4% vs. 33.7%, χ2 = 120.2, p < .001). Despite this, risk documentation was rare among suicide decedents (4 weeks: 13.8%; 52 weeks: 24.5%). Suicide decedents who were male, never married, and non-Hispanic Black were less likely to access care prior to death. Number of mental health encounters was the only predictor of suicide risk documentation among decedents at 4 weeks (OR = 1.14) and 52 weeks (OR = 1.05) prior to their death. Many soldiers who die by suicide access health care shortly before death, presenting an opportunity for suicide prevention. However, in most cases, there was no documentation of prior suicidal thoughts or behaviors, highlighting the need for improvements in risk detection and prediction. Increasing the frequency, scope, and accuracy of risk assessments, especially in mental health care settings, may be particularly useful. (PsycINFO Database Record

Sexual Assault Victimization and Mental Health Treatment, Suicide Attempts, and Career Outcomes Among Women in the US Army.

To examine associations of administratively recorded sexual assault victimization during military service with subsequent mental health and negative career outcomes among US Army women controlling for nonrandom victimization exposure. We used data from the Army Study to Assess Risk and Resilience in Servicemembers to apply propensity score methods to match all 4238 female Regular Army soldiers with administratively recorded sexual assault victimization during 2004 to 2009 to 5 controls per case with similar composite victimization risk. We examined associations of this victimization measure with administratively recorded mental health treatment, suicide attempt, and Army career outcomes over the subsequent 12 months by using survival analysis for dichotomous outcomes and conditional generalized linear models for continuous outcomes. Women with administratively recorded sexual assault had significantly elevated odds ratios (ORs) of subsequent mental health treatment (any, OR = 2.5; 95% confidence interval [CI] = 2.4, 2.6; specialty, OR = 3.1; 95% CI = 2.9, 3.3; inpatient, OR = 2.8; 95% CI = 2.5, 3.1), posttraumatic stress disorder treatment (any, OR = 6.3; 95% CI = 5.7, 6.9; specialty, OR = 7.7; 95% CI = 6.8, 8.6; inpatient, OR = 6.8; 95% CI = 5.4, 8.6), suicide attempt (OR = 3.0; 95% CI = 2.5, 3.6), demotion (OR = 2.1; 95% CI = 1.9, 2.3), and attrition (OR = 1.2; 95% CI = 1.1, 1.2). Sexual assault victimization is associated with considerable suffering and likely decreased force readiness.

Genetic risk variants for social anxiety.

Social anxiety is a neurobehavioral trait characterized by fear and reticence in social situations. Twin studies have shown that social anxiety has a heritable basis, shared with neuroticism and extraversion, but genetic studies have yet to demonstrate robust risk variants. We conducted genomewide association analysis (GWAS) of subjects within the Army Study To Assess Risk and Resilience in Servicemembers (Army STARRS) to (i) determine SNP-based heritability of social anxiety; (ii) discern genetic risk loci for social anxiety; and (iii) determine shared genetic risk with neuroticism and extraversion. GWAS were conducted within ancestral groups (EUR, AFR, LAT) using linear regression models for each of the three component studies in Army STARRS, and then meta-analyzed across studies. SNP-based heritability for social anxiety was significant (h2g = 0.12, P = 2.17 × 10-4 in EUR). One meta-analytically genomewide significant locus was seen in each of EUR (rs708012, Chr 6: BP 36965970, P = 1.55 × 10-8 ; beta = 0.073) and AFR (rs78924501, Chr 1: BP 88406905, P = 3.58 × 10-8 ; beta = 0.265) samples. Social anxiety in Army STARRS was significantly genetically correlated (negatively) with extraversion (rg = -0.52, se = 0.22, P = 0.02) but not with neuroticism (rg = 0.05, se = 0.22, P = 0.81) or with an anxiety disorder factor score (rg = 0.02, se = 0.32, P = 0.94) from external GWAS meta-analyses. This first GWAS of social anxiety confirms a genetic basis for social anxiety, shared with extraversion but possibly less so with neuroticism. © 2017 Wiley Periodicals, Inc.

Pokorny's complaint: The insoluble problem of the overwhelming number of false positives generated by suicide risk assessment

Alex Pokorny's 1983 prospective study of suicide found that 96.3% of high-risk predictions were false positives, and that more than half of the suicides occurred in the low-risk group and were hence false negatives. All subsequent prospective studies, including the recent US Army Study To Assess Risk and Resilience in Servicemembers (STARRS), have reported similar results. We argue that since risk assessment cannot be a practical basis for interventions aimed at reducing suicide, the alternative is for mental health services to carefully consider what amounts to an adequate standard of care, and to adopt the universal precaution of attempting to provide that to all of our patients.

Development, Administration, and Structural Validity of a Brief, Computerized Neurocognitive Battery: Results From the Army Study to Assess Risk and Resilience in Servicemembers.

The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a research project aimed at identifying risk and protective factors for suicide and related mental health outcomes among Army Soldiers. The New Soldier Study component of Army STARRS included the assessment of a range of cognitive- and emotion-processing domains linked to brain systems related to suicidal behavior including posttraumatic stress disorder, mood disorders, substance use disorders, and impulsivity. We describe the design and application of the Army STARRS neurocognitive test battery to a sample of 56,824 soldiers. We investigate its structural and concurrent validity through factor analysis and correlation of scores with demographics. We conclude that, in addition to being composed of previously well-validated measures, the Army STARRS neurocognitive battery as a whole demonstrates good psychometric properties. Correlations of scores with age and sex differences mostly replicate previously published findings, highlighting moderate to large effect sizes even within this restricted age range. Factor structures of scores conform to theoretical expectations. This neurocognitive battery provides a brief, valid measurement of neurocognition that may be helpful in predicting mental health and military performance. These measures can be integrated with neuroimaging to offer a powerful tool for assessing neurocognition in Servicemembers.

Supplemental Material for Health Care Contact and Suicide Risk Documentation Prior to Suicide Death: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

Supplemental Material for Health Care Contact and Suicide Risk Documentation Prior to Suicide Death: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)