Prospective associations of emotion reactivity and risk behaviors with suicide attempts in US Army soldiers

James A. Naifeh, Robert J. Ursano*, Murray B. Stein, Holly B.Herberman Mash, Pablo A. Aliaga, Carol S. Fullerton, Hieu M. Dinh, Tzu Cheg Kao, Nancy A. Sampson, Ronald C. Kessler

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background Emotion reactivity and risk behaviors (ERRB) are transdiagnostic dimensions associated with suicide attempt (SA). ERRB patterns may identify individuals at increased risk of future SAs. Methods A representative sample of US Army soldiers entering basic combat training (n = 21 772) was surveyed and followed via administrative records for their first 48 months of service. Latent profile analysis of baseline survey items assessing ERRB dimensions, including emotion reactivity, impulsivity, and risk-taking behaviors, identified distinct response patterns (classes). SAs were identified using administrative medical records. A discrete-time survival framework was used to examine associations of ERRB classes with subsequent SA during the first 48 months of service, adjusting for time in service, socio-demographic and service-related variables, and mental health diagnosis (MH-Dx). We examined whether associations of ERRB classes with SA differed by year of service and for soldiers with and without a MH-Dx. Results Of 21 772 respondents (86.2% male, 61.8% White non-Hispanic), 253 made a SA. Four ERRB classes were identified: 'Indirect Harming' (8.9% of soldiers), 'Impulsive' (19.3%), 'Risk-Taking' (16.3%), and 'Low ERRB' (55.6%). Compared to Low ERRB, Impulsive [OR 1.8 (95% CI 1.3-2.4)] and Risk-Taking [OR 1.6 (95% CI 1.1-2.2)] had higher odds of SA after adjusting for covariates. The ERRB class and MH-Dx interaction was non-significant. Within each class, SA risk varied across service time. Conclusions SA risk within the four identified ERRB classes varied across service time. Impulsive and Risk-Taking soldiers had increased risk of future SA. MH-Dx did not modify these associations, which may therefore help identify risk in those not yet receiving mental healthcare.

Original languageEnglish
Pages (from-to)6124-6131
Number of pages8
JournalPsychological Medicine
Issue number13
StatePublished - 4 Oct 2023
Externally publishedYes


  • Military
  • emotion reactivity
  • impulsivity
  • risk-taking
  • suicide
  • suicide attempt


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