TY - JOUR
T1 - Predictors of Suicide Attempt Within 30 Days After First Medically Documented Suicidal Ideation in U.S. Army Soldiers
AU - Herberman Mash, Holly B.
AU - Ursano, Robert J.
AU - Kessler, Ronald C.
AU - Naifeh, James A.
AU - Fullerton, Carol S.
AU - Aliaga, Pablo A.
AU - Riggs-Donovan, Charlotte A.
AU - Dinh, Hieu M.
AU - Vance, Mary C.
AU - Wynn, Gary H.
AU - Zaslavsky, Alan M.
AU - Sampson, Nancy A.
AU - Kao, Tzu Cheg
AU - Stein, Murray B.
N1 - Funding Information:
Send correspondence to Dr. Ursano (robert.ursano@usuhs.edu). The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) was sponsored by the Department of the Army and funded under cooperative agreement U01MH087981 (2009–2015) with NIMH. Subsequently, the STARRS Longitudinal Study was sponsored and funded by the Department of Defense (Uniformed Services University of the Health Sciences grant). Both grants were administered by the Henry M. Jackson Foundation for the Advancement of Military Medicine. As a cooperative agreement, scientists employed by NIMH (Lisa J. Colpe, Ph.D., M.P.H., and Michael Schoenbaum, Ph.D.) and Army liaisons/consultants (Steven Cersovsky, M.D., M.P.H., and Kenneth Cox, M.D., M.P.H., of the U.S. Army Public Health Center) collaborated to develop the study protocol and data collection instruments, supervise data collection, interpret results, and prepare reports. Although a draft of the manuscript was submitted to the Army and NIMH for review and comment prior to submission, this was with the understanding that comments would be no more than advisory. The Army STARRS Team consists of co–principal investigators Robert J. Ursano, M.D. (Uniformed Services University of the Health Sciences) and Murray B. Stein, M.D., M.P.H. (University of California, San Diego and VA San Diego Healthcare System); site principal investigators Steven Heer-inga, Ph.D. (University of Michigan), James Wagner, Ph.D. (University of Michigan), and Ronald C. Kessler, Ph.D. (Harvard Medical School); Army scientific consultant/liaison Kenneth Cox, M.D., M.P.H. (Office of the Deputy Under Secretary of the Army); other team members include Pablo A. Aliaga, M.A. (Uniformed Services University of the Health Sciences), David M. Benedek, M.D. (Uniformed Services University of the Health Sciences), Laura Campbell-Sills, Ph.D. (University of California, San Diego), Carol S. Fullerton, Ph.D. (Uniformed Services University of the Health Sciences), Nancy Gebler, M.A. (University of Michigan), Robert K. Gifford, Ph.D. (Uniformed Services University of the Health Sciences), Meredith House, B.A. (University of Michigan), Paul E. Hurwitz, M.P.H. (Uniformed Services University of the Health Sciences), Sonia Jain, Ph.D. (University of California, San Diego), Tzu-Cheg Kao, Ph.D. (Uniformed Services University of the Health Sciences), Lisa Lewandowski-Romps, Ph.D. (University of Michigan), Holly Herberman Mash, Ph.D. (Uniformed Services University of the Health Sciences), James A. Naifeh, Ph.D. (Uniformed Services University of the Health Sciences), Tsz Hin Hinz Ng, M.P.H. (Uniformed Services University of the Health Sciences), Matthew K. Nock, Ph.D. (Harvard University), Nancy A. Sampson, B.A. (Harvard Medical School), Gary H. Wynn, M.D. (Uniformed Services University of the Health Sciences), and Alan M. Zaslavsky, Ph.D. (Harvard Medical School).
Funding Information:
Dr. Kessler has received support for epidemiological studies from Sanofi-Aventis; he has served as a consultant for DataStat, Holmusk, Johnson & Johnson Wellness and Prevention, RallyPoint Networks, Sage Pharmaceuticals, Shire, and Takeda and on advisory boards for Johnson & Johnson Services Lake Nona Life Project; and he has stock options in Mirah, PYM, and Roga Sciences. Dr. Stein has received research support from the Department of Defense, the Department of Veterans Affairs, and NIH; he has served as a consultant for Actelion, Acadia Pharmaceuticals, Aptinyx, ATAI Life Sciences, Boehringer Ingelheim, Bionomics, BioXcel Therapeutics, Clexio, EmpowerPharm, Engrail Therapeutics, GW Pharmaceuticals, Janssen, Jazz Pharmaceuticals, and Roche/Genentech and on scientific advisory boards for the Anxiety and Depression Association of America and the Brain and Behavior Research Foundation; he receives remuneration for his editorial work on Depression and Anxiety (Editor-in-Chief), Biological Psychiatry (Deputy Editor), and UpTo-Date (Co-Editor-in-Chief for Psychiatry); and he has stock options in Epi-vario and Oxeia Biopharmaceuticals. The other authors report no financial relationships with commercial interests.
Publisher Copyright:
© 2021 American Psychiatric Association. All rights reserved.
PY - 2021/11
Y1 - 2021/11
N2 - Objective: The authors sought to identify predictors of imminent suicide attempt (within 30 days) among U.S. Army soldiers following their first documented suicidal ideation. Methods: Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers, the authors identified 11,178 active-duty Regular Army enlisted soldiers (2006-2009) with medically documented suicidal ideation and no prior medically documented suicide attempts. The authors examined risk factors for suicide attempt within 30 days of first suicidal ideation using logistic regression analyses, including sociodemographic and service-related characteristics, psychiatric diagnoses, physical health care visits, injuries, and history of family violence or crime perpetration or victimization. Results: Among soldiers with first documented suicidal ideation, 830 (7.4%) attempted suicide, 46.3% of whom (N5387) attempted suicide within 30 days (rate, 35.4 per 1,000 soldiers). Following a series of multivariate analyses, the final model identified females (odds ratio51.3, 95% CI51.0, 1.8), combat medics (odds ratio51.6, 95% CI51.1, 2.2), individuals with an anxiety disorder diagnosis prior to suicidal ideation (odds ratio51.3, 95% CI51.0, 1.6), and those who received a sleep disorder diagnosis on the same day as the recorded suicidal ideation (odds ratio52.3, 95% CI51.1, 4.6) as being more likely to attempt suicide within 30 days. Black soldiers (odds ratio50.6, 95% CI50.4, 0.9) and those who received an anxiety disorder diagnosis on the same day as suicidal ideation (odds ratio50.7, 95% CI50.5, 0.9) were less likely. Conclusions: Suicide attempt risk is highest in the first 30 days following ideation diagnosis and is more likely among women, combat medics, and soldiers with an anxiety disorder diagnosis before suicidal ideation and a sameday sleep disorder diagnosis. Black soldiers and those with a same-day anxiety disorder diagnosis were at decreased risk. These factors may help identify soldiers at imminent risk of suicide attempt.
AB - Objective: The authors sought to identify predictors of imminent suicide attempt (within 30 days) among U.S. Army soldiers following their first documented suicidal ideation. Methods: Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers, the authors identified 11,178 active-duty Regular Army enlisted soldiers (2006-2009) with medically documented suicidal ideation and no prior medically documented suicide attempts. The authors examined risk factors for suicide attempt within 30 days of first suicidal ideation using logistic regression analyses, including sociodemographic and service-related characteristics, psychiatric diagnoses, physical health care visits, injuries, and history of family violence or crime perpetration or victimization. Results: Among soldiers with first documented suicidal ideation, 830 (7.4%) attempted suicide, 46.3% of whom (N5387) attempted suicide within 30 days (rate, 35.4 per 1,000 soldiers). Following a series of multivariate analyses, the final model identified females (odds ratio51.3, 95% CI51.0, 1.8), combat medics (odds ratio51.6, 95% CI51.1, 2.2), individuals with an anxiety disorder diagnosis prior to suicidal ideation (odds ratio51.3, 95% CI51.0, 1.6), and those who received a sleep disorder diagnosis on the same day as the recorded suicidal ideation (odds ratio52.3, 95% CI51.1, 4.6) as being more likely to attempt suicide within 30 days. Black soldiers (odds ratio50.6, 95% CI50.4, 0.9) and those who received an anxiety disorder diagnosis on the same day as suicidal ideation (odds ratio50.7, 95% CI50.5, 0.9) were less likely. Conclusions: Suicide attempt risk is highest in the first 30 days following ideation diagnosis and is more likely among women, combat medics, and soldiers with an anxiety disorder diagnosis before suicidal ideation and a sameday sleep disorder diagnosis. Black soldiers and those with a same-day anxiety disorder diagnosis were at decreased risk. These factors may help identify soldiers at imminent risk of suicide attempt.
UR - http://www.scopus.com/inward/record.url?scp=85121944705&partnerID=8YFLogxK
U2 - 10.1176/appi.ajp.2021.20111570
DO - 10.1176/appi.ajp.2021.20111570
M3 - Article
C2 - 34465200
AN - SCOPUS:85121944705
SN - 0002-953X
VL - 178
SP - 1050
EP - 1059
JO - American Journal of Psychiatry
JF - American Journal of Psychiatry
IS - 11
ER -