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

  • Naifeh, James A1, 2
  • Ursano, Robert J1
  • Stein, Murray B3, 4
  • Mash, Holly B Herberman1, 2
  • Aliaga, Pablo A1, 2
  • Fullerton, Carol S1
  • Dinh, Hieu M1, 2
  • Kao, Tzu-Cheg5
  • Sampson, Nancy A6
  • Kessler, Ronald C6
  • 1 Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
  • 2 Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.
  • 3 Department of Psychiatry and School of Public Health, University of California San Diego, La Jolla, CA, USA.
  • 4 VA San Diego Healthcare System, San Diego, CA, USA.
  • 5 Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
  • 6 Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Published Article
Psychological Medicine
Cambridge University Press
Publication Date
Oct 01, 2023
DOI: 10.1017/S0033291722003300
PMID: 36330831


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. 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. 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. 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.

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