Association of emotion reactivity and distress intolerance with suicide attempts in U.S. Army soldiers

James A. Naifeh, Matthew K. Nock, Catherine L. Dempsey, Matthew W. Georg, Pablo A. Aliaga, Hieu M. Dinh, Carol S. Fullerton, Holly B.Herberman Mash, Tzu Cheg Kao, Nancy A. Sampson, Gary H. Wynn, Alan M. Zaslavsky, Murray B. Stein, Ronald C. Kessler, Robert J. Ursano*, Steven Heeringa, James Wagner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Introduction: Emotion reactivity (ER) and distress intolerance (DI) may be associated with increased suicide attempt (SA) risk among U.S. Army soldiers. Method: In this case–control study, 74 soldiers recently hospitalized for SA (cases) were compared with 133 control soldiers from the same Army installations selected based on either propensity score matching (n = 103) or reported 12-month suicide ideation (SI) (n = 30). Controls were weighted to represent the total Army population at the study sites and the subpopulation of 12-month ideators. Participants completed questionnaires assessing ER, DI, and other psychosocial variables. Logistic regression analyses examined whether ER and DI differentiated SA cases from the general population and from 12-month ideators before and after controlling for additional important risk factors (sociodemographic characteristics, stressors, mental disorders). Results: In univariate analyses, ER differentiated SA cases from both the general population (OR = 2.5[95%CI = 1.7–3.6]) and soldiers with 12-month SI (OR = 2.5[95%CI = 1.3–4.6]). DI also differentiated cases from the general population (OR = 2.9[95%CI = 2.0–4.1]) and 12-month ideators (OR = 1.9[95%CI = 1.1–3.5]). These associations persisted after controlling for sociodemographic variables, stressors, and mental disorders. Conclusion: Findings provide evidence that higher ER and DI are associated with increased risk of SA among soldiers, even after adjusting for known risk factors. Prospective research with larger samples is needed.

Original languageEnglish
Pages (from-to)289-302
Number of pages14
JournalSuicide and Life-Threatening Behavior
Issue number2
StatePublished - Apr 2022
Externally publishedYes


  • military
  • suicide attempt


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