Assessing Risk & Protective Factors for Suicide in US Army Soldiers Michael Schoenbaum, PhD November 2, 2012
Affiliations National Institute of Mental Health Rand Corporation (Senior Economist, adjunct) University of Michigan (research associate, Population Studies Center) (None) Conflicts to Disclose
Active Duty Army Suicides Number of Suicide Deaths 200 150 100 50 0 2004 2005 2006 2007 2008 2009 SOURCE: Army G-1
Active Duty Army Suicides Number of Suicide Deaths 200 150 100 50 0 2004 2005 2006 2007 2008 2009 SOURCE: Army G-1
Active Duty Army Suicide Rate Suicides/100,000 person-years of Army service 25 20 15 10 5 0 2004 2005 2006 2007 2008 2009 SOURCES: Army STARRS calculations
US Civilian Suicide Statistics Suicide, accident, and homicide are the three leading causes of death among young adults (CDC, www.cdc.gov/ ncipc/wisqars) In 2008, suicide deaths (36,035) outnumbered homicide deaths (17,826) (CDC) Non-fatal suicide attempts are 10-30 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)
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
SOURCE: http://fayobserver.com/articles/2011/07/31/1111772?sac=home
Impact of Heart Disease Research Deaths per 100,000 500 400 300 200 100 1950 1960 1970 1980 1990 2000 Year ~ 1,329,000 Projected Deaths in 2000 ~ 514,000 Actual Deaths in 2000 63% decrease in mortality ~ 1 million premature deaths/ year averted $2.6 trillion in economic return New, effective treatments & prevention strategies
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, http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof
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
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
Historical Data Study - Overview 1.6 million Soldiers in study population: - Soldiers who served on active duty (>30 days) in 2004-2009 - Regular Army, + activated Guard & Reserve Data from ~39 Army/DoD databases Study receiving all available records from 2000-2009 > 1.1 billion data records
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, 2012 - N=31,629 blood vials collected as of Oct. 13, 2012
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
Neurocognitive Tests in NSS 1. Sensorimotor processing: hand-eye coordination 1. 2. E 2. Continuous performance test: vigilance/impulsiveness 3. 4. 3. Emotion ID test: identifying facial expressions 4. Facial memory test: visual/ face memory 5. 6. 5. 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
New Soldier Study CONUS Computerized Surveys Ft. Leonard Wood Ft. Benning Ft. Jackson
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, 2012 - Includes N=10,255 in-theater (inbound & outbound R&R)
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
All Army Study CONUS Surveys
All Army Study Sites
Pre/Post Deployment Study
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
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
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
Active Duty Army Suicide Rate Army Civilian (matched by age & sex) Suicides/100,000 person-years 25 20 15 10 5 0 Operation Desert Storm Somalia Bosnia Kosovo Operation Enduring Freedom Operation Iraqi Freedom 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 SOURCES: Army G-1 (Army); Centers for Disease Control (civilian)
Active Duty Army Suicide Rate Army Civilian (matched by age & sex) Suicides/100,000 person-years 25 20 15 10 5 0 2004 2005 2006 2007 2008 2009 SOURCES: Army STARRS calculations (Army); Centers for Disease Control (civilian)
Active Duty Army Suicide Rate Currently Deployed Previously Deployed Never Deployed Suicides/100,000 person-years of Army service 30 25 20 15 10 5 0 2004 2005 2006 2007 2008 2009 SOURCE: Army STARRS calculations
Active Duty Army Suicide Rate Currently Deployed Previously Deployed Never Deployed Suicides/100,000 person-years of Army service 30 25 20 15 10 5 0 2004 2005 2006 2007 2008 2009 SOURCE: Army STARRS calculations
Active Duty Army Suicide Rate Currently Deployed Previously Deployed Never Deployed Suicides/100,000 person-years of Army service 30 25 20 15 10 5 0 2004 2005 2006 2007 2008 2009 SOURCE: Army STARRS calculations
www.armystarrs.org