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Associations of vulnerability to stressful life events with suicide attempts after active duty among high-risk soldiers: results from the Study to Assess Risk and Resilience in Servicemembers-longitudinal study (STARRS-LS)

Published online by Cambridge University Press:  27 May 2022

Carol Chu ,
Ian H. Stanley ,
Brian P. Marx ,
Andrew J. King ,
Dawne Vogt ,
Sarah M. Gildea ,
Irving H. Hwang ,
Nancy A. Sampson ,
Robert O'Brien  and
Murray B. Stein
...Show all authors
Carol Chu
Affiliation:
Minneapolis VA Health Care System, Minneapolis, MN, USA Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
Ian H. Stanley
Affiliation:
National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
Brian P. Marx
Affiliation:
National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
Andrew J. King
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Dawne Vogt
Affiliation:
National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
Sarah M. Gildea
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Irving H. Hwang
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Nancy A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Robert O'Brien
Affiliation:
VA Health Services Research and Development Service, Washington, DC, USA
Murray B. Stein
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA School of Public Health, University of California San Diego, La Jolla, CA, USA VA San Diego Healthcare System, La Jolla, CA, USA
Robert J. Ursano
Affiliation:
Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
Ronald C. Kessler*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
*
Author for correspondence: Ronald C. Kessler, E-mail: kessler@hcp.med.harvard.edu
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Abstract

Background

The transition from military service to civilian life is a high-risk period for suicide attempts (SAs). Although stressful life events (SLEs) faced by transitioning soldiers are thought to be implicated, systematic prospective evidence is lacking.

Methods

Participants in the Army Study to Assess Risk and Resilience in Servicemembers (STARRS) completed baseline self-report surveys while on active duty in 2011–2014. Two self-report follow-up Longitudinal Surveys (LS1: 2016–2018; LS2: 2018–2019) were subsequently administered to probability subsamples of these baseline respondents. As detailed in a previous report, a SA risk index based on survey, administrative, and geospatial data collected before separation/deactivation identified 15% of the LS respondents who had separated/deactivated as being high-risk for self-reported post-separation/deactivation SAs. The current report presents an investigation of the extent to which self-reported SLEs occurring in the 12 months before each LS survey might have mediated/modified the association between this SA risk index and post-separation/deactivation SAs.

Results

The 15% of respondents identified as high-risk had a significantly elevated prevalence of some post-separation/deactivation SLEs. In addition, the associations of some SLEs with SAs were significantly stronger among predicted high-risk than lower-risk respondents. Demographic rate decomposition showed that 59.5% (s.e. = 10.2) of the overall association between the predicted high-risk index and subsequent SAs was linked to these SLEs.

Conclusions

It might be possible to prevent a substantial proportion of post-separation/deactivation SAs by providing high-risk soldiers with targeted preventive interventions for exposure/vulnerability to commonly occurring SLEs.

Keywords

Predictive analyticsSTARRSsuicide attemptstransitional servicesveterans
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 9 , July 2023 , pp. 4181 - 4191
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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