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Prospective associations of emotion reactivity and risk behaviors with suicide attempts in US Army soldiers

Published online by Cambridge University Press:  04 November 2022

James A. Naifeh ,
Robert J. Ursano Open the ORCID record for Robert J. Ursano [Opens in a new window] ,
Murray B. Stein ,
Holly B. Herberman Mash ,
Pablo A. Aliaga ,
Carol S. Fullerton ,
Hieu M. Dinh ,
Tzu-Cheg Kao ,
Nancy A. Sampson  and
Ronald C. Kessler
James A. Naifeh
Affiliation:
Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, 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
Murray B. Stein
Affiliation:
Department of Psychiatry and School of Public Health, University of California San Diego, La Jolla, CA, USA VA San Diego Healthcare System, San Diego, CA, USA
Holly B. Herberman Mash
Affiliation:
Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
Pablo A. Aliaga
Affiliation:
Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
Carol S. Fullerton
Affiliation:
Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
Hieu M. Dinh
Affiliation:
Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
Tzu-Cheg Kao
Affiliation:
Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
Nancy A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Ronald C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
*
Author for correspondence: Robert J. Ursano, E-mail: robert.ursano@usuhs.edu
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Abstract

Background

Emotion reactivity and risk behaviors (ERRB) are transdiagnostic dimensions associated with suicide attempt (SA). ERRB patterns may identify individuals at increased risk of future SAs.

Methods

A representative sample of US Army soldiers entering basic combat training (n = 21 772) was surveyed and followed via administrative records for their first 48 months of service. Latent profile analysis of baseline survey items assessing ERRB dimensions, including emotion reactivity, impulsivity, and risk-taking behaviors, identified distinct response patterns (classes). SAs were identified using administrative medical records. A discrete-time survival framework was used to examine associations of ERRB classes with subsequent SA during the first 48 months of service, adjusting for time in service, socio-demographic and service-related variables, and mental health diagnosis (MH-Dx). We examined whether associations of ERRB classes with SA differed by year of service and for soldiers with and without a MH-Dx.

Results

Of 21 772 respondents (86.2% male, 61.8% White non-Hispanic), 253 made a SA. Four ERRB classes were identified: ‘Indirect Harming’ (8.9% of soldiers), ‘Impulsive’ (19.3%), ‘Risk-Taking’ (16.3%), and ‘Low ERRB’ (55.6%). Compared to Low ERRB, Impulsive [OR 1.8 (95% CI 1.3–2.4)] and Risk-Taking [OR 1.6 (95% CI 1.1–2.2)] had higher odds of SA after adjusting for covariates. The ERRB class and MH-Dx interaction was non-significant. Within each class, SA risk varied across service time.

Conclusions

SA risk within the four identified ERRB classes varied across service time. Impulsive and Risk-Taking soldiers had increased risk of future SA. MH-Dx did not modify these associations, which may therefore help identify risk in those not yet receiving mental healthcare.

Keywords

Militarysuicidesuicide attemptemotion reactivityimpulsivityrisk-taking
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 13 , October 2023 , pp. 6124 - 6131
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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