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

Authors
  • 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.
Type
Published Article
Journal
Psychological Medicine
Publisher
Cambridge University Press
Publication Date
Oct 01, 2023
Volume
53
Issue
13
Pages
6124–6131
Identifiers
DOI: 10.1017/S0033291722003300
PMID: 36330831
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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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