Assessing Risk & Protective Factors for Suicide in US Army Soldiers. Michael Schoenbaum, PhD November 2, 2012

Transcription

1 Assessing Risk & Protective Factors for Suicide in US Army Soldiers Michael Schoenbaum, PhD November 2, 2012

2 Affiliations National Institute of Mental Health Rand Corporation (Senior Economist, adjunct) University of Michigan (research associate, Population Studies Center) (None) Conflicts to Disclose

3 Active Duty Army Suicides Number of Suicide Deaths SOURCE: Army G-1

4 Active Duty Army Suicides Number of Suicide Deaths SOURCE: Army G-1

5 Active Duty Army Suicide Rate Suicides/100,000 person-years of Army service SOURCES: Army STARRS calculations

6 US Civilian Suicide Statistics Suicide, accident, and homicide are the three leading causes of death among young adults (CDC, ncipc/wisqars) In 2008, suicide deaths (36,035) outnumbered homicide deaths (17,826) (CDC) Non-fatal suicide attempts are times more frequent than suicide deaths (CDC) 1.1 million adults (0.5% of the adult population) aged 18 years and older reported making a suicide attempt in 2008 (SAMHSA, National Drug Use & Health, 2008)

7

8 Purpose of the Study To guide the development of data-driven methods to lessen or prevent suicide behaviors and improve Soldiers overall mental health and functioning Identify salient risk and protective factors Inform development & testing of empirically-derived interventions

9 SOURCE:

10 Impact of Heart Disease Research Deaths per 100, Year ~ 1,329,000 Projected Deaths in 2000 ~ 514,000 Actual Deaths in % decrease in mortality ~ 1 million premature deaths/ year averted $2.6 trillion in economic return New, effective treatments & prevention strategies

11 Empirically Derived Interventions Predic'ng*a*low* frequency,*fatal* outcome*** Empirically* iden.fied,*mul.ple* weak *risk*factors** Risk%factors%inform% development%of% prac3cal% preven3ve% interven3ons%% Summary'risk' score'' Source: National Heart, Lung & Blood Institute,

12 Study Overview Five study components Active duty Army soldiers - Regular Army - Activated National Guard - Activated Army Reserve Voluntary - scrambled - Chain of command will not see responses - Safety plan

13 Main Study Components Historical Data Study Army and DoD data on active duty soldiers and suicide events between 2004 and 2009 New Soldier Study Assessing the health, personal characteristics, & prior experiences of new soldiers as they begin Army service All Army Study Assessing soldiers across all phases of Army service Soldier Health Outcomes Studies Assessing suicide attempt survivors, suicide decedents, & controls Special Studies

14 Historical Data Study - Overview 1.6 million Soldiers in study population: - Soldiers who served on active duty (>30 days) in Regular Army, + activated Guard & Reserve Data from ~39 Army/DoD databases Study receiving all available records from > 1.1 billion data records

15 New Soldier Study (NSS) Launched February 2011 Samples of incoming recruits at Basic Training 2 x 75 minute surveys, including neurocognitive testing Participants asked to consent to linking Army/DoD administrative data Target enrollment: 55,000 soldiers (25,000 with blood samples) - N=50,800 complete as of Oct. 13, N=31,629 blood vials collected as of Oct. 13, 2012

16 New Soldier Study - Content Session 1 Tell us about yourself Your health ADHD Depression High mood Anxiety Irritability & anger Panic attacks Anger attacks Stressful experiences Spirituality Treatment How you see yourself Neurocognitive tests Session 2 Injuries Tobacco, alcohol, drugs Self-harm Family history Social support Childhood How you see yourself Neurocognitive tests

17 Neurocognitive Tests in NSS 1. Sensorimotor processing: hand-eye coordination E 2. Continuous performance test: vigilance/impulsiveness Emotion ID test: identifying facial expressions 4. Facial memory test: visual/ face memory N-back test: attention and working memory 6. Conditional exclusion test: 7. Go no-go test: impulsiveness 8. Stroop test: emotional interference 7. X 8. SUICIDE

18 New Soldier Study CONUS Computerized Surveys Ft. Leonard Wood Ft. Benning Ft. Jackson

19 All Army Study (AAS) Launched January 2011 Representative sample of active Army units, across CONUS, OCONUS, & in-theater We seek to survey all soldiers in each sampled unit 60 minute surveys We ask participants to consent to matching Army/DoD administrative data Target enrollment: 35,000 soldiers - N=27,638 complete as of Oct. 13, Includes N=10,255 in-theater (inbound & outbound R&R)

20 All Army Study - Components Tell us about yourself Your health Injuries History of emotional problems Tobacco, alcohol, drugs Attention & concentration Depression High mood Anxiety Irritability and anger Panic attacks Anger attacks Self-harm Deployment experiences Stressful experiences Counseling/treatment Unit experiences/cohesion Resilience Weapon ownership Social networks Spirituality Childhood

21 All Army Study CONUS Surveys

22 All Army Study Sites

23 Pre/Post Deployment Study

24 Other Army STARRS Components: Soldier Health Outcome Studies Incident suicide attempt survivors who are hospitalized in 5 main Military Treatment Facilities (SHOS-A) - we interview the soldier Incident suicide decedents (SHOS-B) - we interview soldiers next of kin & Army supervisor Comparison control soldiers selected from All Army Survey

25 Neurocognitive Tests in SHOS-A - 8 NSS tests, plus Death 1. Suicide implicit association test: death Me Suicide Life Not Me 2. Orienting of attention task: attention to suicide/trauma-related information OVERDOSE 3. Attention disengagement task: trouble disengaging from suicide/traumarelated information K SUICIDE

26 SHOS-A & SHOS-B In-person and phone interviews Joint Base Lewis-McChord SHOS-B Interviews, University of Michigan Walter Reed National Military Medical Center Ft. Hood Ft. Stewart Ft. Bragg

27 Active Duty Army Suicide Rate Army Civilian (matched by age & sex) Suicides/100,000 person-years Operation Desert Storm Somalia Bosnia Kosovo Operation Enduring Freedom Operation Iraqi Freedom SOURCES: Army G-1 (Army); Centers for Disease Control (civilian)

28 Active Duty Army Suicide Rate Army Civilian (matched by age & sex) Suicides/100,000 person-years SOURCES: Army STARRS calculations (Army); Centers for Disease Control (civilian)

29 Active Duty Army Suicide Rate Currently Deployed Previously Deployed Never Deployed Suicides/100,000 person-years of Army service SOURCE: Army STARRS calculations

30 Active Duty Army Suicide Rate Currently Deployed Previously Deployed Never Deployed Suicides/100,000 person-years of Army service SOURCE: Army STARRS calculations

31 Active Duty Army Suicide Rate Currently Deployed Previously Deployed Never Deployed Suicides/100,000 person-years of Army service SOURCE: Army STARRS calculations

32