The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS): progress toward understanding suicide among soldiers

Abstract

Responding to an unprecedented increase in the suicide rate among soldiers, in 2008 the US Army and US National Institute of Mental Health funded the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), a multicomponent epidemiological and neurobiological study of risk and resilience factors for suicidal thoughts and behaviors, and their psychopathological correlates among Army personnel. Using a combination of administrative records, representative surveys, computerized neurocognitive tests, and blood samples, Army STARRS and its longitudinal follow-up study (STARRS-LS) are designed to identify potentially actionable findings to inform the Army's suicide prevention efforts. The current report presents a broad overview of Army STARRS and its findings to date on suicide deaths, attempts, and ideation, as well as other important outcomes that may increase suicide risk (e.g., mental disorders, sexual assault victimization). The findings highlight the complexity of environmental and genetic risk and protective factors in different settings and contexts, and the importance of life and career history in understanding suicidal thoughts and behaviors.

Fig. 1

Vulnerability–stress model of suicidal behavior. (Reprinted with permission from Nock et al. [10])

Fig. 2

Suicide deaths per 100,000 person-years of active duty Army service among never deployed, currently deployed, and previously deployed Regular Army soldiers in the Army STARRS Historical Administrative Data Study (HADS), 2004–2009. Shown are Regular Army 12-month moving averages. Each line represents a 12-month moving average (i.e., each respective dot reports the rate for the prior 12-month period). (Reprinted with permission from Schoenbaum et al. [32])

Fig. 3

Risk of suicide attempt by month since entering service among Regular Army enlisted soldiers and officers in the Army STARRS Historical Administrative Data Study (HADS), 2004–2009. Discrete-time hazard functions were used to calculate risk estimates (suicide attempters per 100,000 person-months) for each month since entering Army service. (Reprinted with permission from Ursano et al. [38])

Fig. 4

Crude rates of suicide attempt and suicide death by deployment status among Regular Army enlisted soldiers in the Army STARRS Historical Administrative Data Study (HADS), 2004–2009

Fig. 5

Monthly risk of suicide attempt risk by deployment status among Regular Army enlisted soldiers in the Army STARRS Historical Administrative Data Study (HADS), 2004–2009. The sample of enlisted soldiers (never deployed soldiers in their first year of service, n = 24,741; currently deployed soldiers on their first deployment, n = 13,833; and previously deployed soldiers after their first deployment, n = 38,281) is a subset of the total sample (n = 193,617 person-months) from the Army STARRS Historical Administrative Data Study (HADS). Monthly risk based on hazard rates and linear spline models. (Reprinted with permission from Ursano et al. [40])