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. 2024 Sep:7:100064.
doi: 10.1016/j.xjmad.2024.100064. Epub 2024 Mar 16.

Suicide without warning: Results from the Army Study to Assess Risk and Resilience in Servicemembers (STARRS)

Catherine L Dempsey  1   2 , Jingning Ao  1   2 , Matthew W Georg  1   2 , Pablo A Aliaga  1   2 , David A Brent  3 , David M Benedek  1 , Kelly L Zuromski  4 , Matthew K Nock  4 , Steven G Heeringa  5 , Ronald C Kessler  6 , Murray B Stein  7   8 , Robert J Ursano  1
Affiliations

Suicide without warning: Results from the Army Study to Assess Risk and Resilience in Servicemembers (STARRS)

Catherine L Dempsey et al. J Mood Anxiety Disord. 2024 Sep.

Abstract

Objectives: The rate of suicide increased in members of the United States Army since 2011 after the Iraq and Afghanistan wars and continues to be a major concern. In order to reverse this disturbing trend, it is vital to understand the risk and protective factors for suicide death in servicemembers.

Methods: Data were obtained from a case-control psychological autopsy study, which compared U.S. Army suicide decedent cases (n = 135) to a probability sample of living controls (n = 255) who are also service members weighted to be representative of the Army. Interviews were conducted with next-of-kin (NOK) and supervisor (SUP) informants. Multivariable logistic regressions models were constructed using predictors significant after controlling for multiple comparisons.

Results: The most parsimonious multivariable model controlling for deployment status, as reported by SUP predicting suicide death consisted of four significant variables: a spouse or partner left him or her in the past month (OR = 28.5 [95% CI = 1.8, 442.7] χ2 = 5.72, p = .0168); a smaller social network (OR = 4.2 [95% CI = 1.0, 17.3] χ2 = 3.97, p = .0462), less likely to seek help from a mental health counselor (OR = 3.4 [95% CI = 1.2, 9.7] χ2 = 5.35, p = .0207) and more likely to be described as incautious (OR = 3.8 [95% CI = 1.2, 11.7] χ2 = 5.42, p = .0199). The AUC = .88 [95%CI = 0.82, 0.94] for this regression model suggests strong prediction.

Conclusions: Our findings suggest that recent relationship problems, especially in soldiers who are less likely to seek out support from others, may be warning signs for detection and prevention of imminent risk of suicide and according to supervisor informant surveys, had neither evidence of a mental health disorder, nor disclosed suicidal ideation or self-harm. Implications for suicide prevention are discussed.

Keywords: Military psychiatry; Psychological autopsy; Suicide; Suicide prevention.

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Conflict of interest statement

If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
ROC curve for risk score logistic regression model of suicide.
See this image and copyright information in PMC

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