Mental Disorders,Comorbidity, and Pre‐enlistment Suicidal Behavior Among New Soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

We examined the associations between mental disorders and suicidal behavior (ideation, plans, and attempts) among new soldiers using data from the New Soldier Study (NSS) component of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS; N = 38,507). Most new soldiers with a pre‐enlistment history of suicide attempt reported a prior mental disorder (59.0%). Each disorder examined was associated with increased odds of suicidal behavior (ORs = 2.6–8.6). Only PTSD and disorders characterized by irritability and impulsive/aggressive behavior (i.e., bipolar disorder, conduct disorder, oppositional defiant disorder, and attention‐deficit/hyperactivity disorder) predicted unplanned attempts among ideators. Mental disorders are important predictors of pre‐enlistment suicidal behavior among new soldiers and should figure prominently in suicide screening and prevention efforts.     

Prior Health Care Utilization Patterns and Suicide Among U.S. Army Soldiers

Suicides among U.S. Army soldiers are increasing and, in January 2009, outpaced deaths due to combat. For this study, 1,873 army suicides identified through death, inpatient, and emergency room records were matched with 5,619 controls. In multivariate models, older, male, White, single, and enlisted soldiers with a prior injury (OR = 2.04, 95% CI = 1.64‐2.54), alcohol (OR = 3.41, 95% CI = 2.32‐4.99), or mental health hospitalization (OR = 6.62, 95% CI = 4.77‐9.20) were at increased risk for suicide. Risk was greatest immediately following diagnoses, but remained elevated even after 5 or more years of follow‐up. Most injury hospitalizations were unintentional but, nonetheless, significantly associated with suicide. Interactions indicate soldiers with both mental health and injury history are particularly vulnerable.     

Neurocognitive Function and Suicide in U.S. Army Soldiers

This prospective cohort study used administrative data from the Army Study to Assess Risk and Resilience in Servicemembers to examine associations between neurocognitive functioning and subsequent suicidal events among Regular Army enlisted soldiers during the years 2004–2009. Cases were all soldiers who completed the Army's Automated Neuropsychological Assessment Metrics (ANAM) computerized testing battery prior to documented suicide attempt (n = 607), ideation (n = 955), or death (n = 57). Controls were an equal‐probability sample of 9,893 person‐months from other soldiers. Exploratory factor analysis of five ANAM tests identified a general neurocognitive factor that excluded the mathematic processing test (MTH). When examined separately in logistic regression analyses that controlled for sociodemographics and prior mental health diagnosis, both the general neurocognitive factor (logit [β] = ?.197 to ?.521; p < .01) and MTH (β = ?.024 to ?.064; p < .05) were associated with all outcomes. When both predictors were examined simultaneously, the general neurocognitive factor continued to be associated with all outcomes (β = ?.164 to ?.417; p < .05) and MTH continued to be associated with suicide attempt (β = ?.015; p = .046) and ideation (β = ?.014; p = .018). These small but robust associations suggest that future research must continue to examine the extent to which objective neurocognitive tests may enhance understanding and prediction of suicide risk.     

Prior Mental Disorders and Lifetime Suicidal Behaviors Among US Army Soldiers in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

We report on associations of retrospectively reported temporally prior mental disorders and Army career characteristics with subsequent first onset of suicidal behaviors in a large, representative sample of US Army soldiers who participated in the Consolidated All‐Army Survey of the Army Study to Assess Risk and Resilience in Servicemembers (N = 29,982). Results reveal that among men and women, all self‐reported lifetime disorders measured (some assessed with screening scales) are associated with subsequent onset of suicide ideation. Among men, three disorders characterized by agitation and impulsiveness (intermittent explosive disorder, panic disorder, and substance disorders) predict the transition from suicide ideation to attempt. For both men and women, being in the Regular Army (vs. National Guard or Army Reserve) predicts suicide attempts in the total sample. For men, a history of deployment and junior rank are predictors of suicide attempts after adjusting for preenlistment disorders but not accounting for pre‐ and postenlistment disorders, suggesting that postenlistment disorders account for some of the increased suicide risk among these career characteristics. Overall, these results highlight associations between mental disorders and suicidal behaviors, but underscore limitations predicting which people with ideation attempt suicide.     

Lifetime Suicidal Behaviors and Career Characteristics Among U.S. Army Soldiers: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

The current report presents data on lifetime prevalence of suicide ideation and nonfatal attempts as reported by the large representative sample of U.S. Army soldiers who participated in the Consolidated All‐Army Survey of the Army Study to Assess Risk and Resilience in Servicemembers (N  =  29,982). We also examine associations of key Army career characteristics with these outcomes. Prevalence estimates for lifetime suicide ideation are 12.7% among men and 20.1% among women, and for lifetime suicide attempts are 2.5% and 5.1%, respectively. Retrospective age‐of‐onset reports suggest that 53.4%–70% of these outcomes had preenlistment onsets. Results revealed that, for both men and women, being in the Regular Army, compared with being in the National Guard or Army Reserve, and being in an enlisted rank, compared with being an officer, is associated with increased risk of suicidal behaviors and that this elevated risk is present both before and after joining the Army.     

Comparison of Suicide Attempters and Decedents in the U.S. Army: A Latent Class Analysis

A clearer understanding of risk factors for suicidal behavior among soldiers is of principal importance to military suicide prevention. It is unclear whether soldiers who attempt suicide and those who die by suicide have different patterns of risk factors. As such, preventive efforts aimed toward reducing suicide attempts and suicides, respectively, may require different strategies. We conducted a latent class analysis (LCA) to examine classes of risk factors among suicide attempters (n = 1,433) and decedents (n = 424). Both groups were represented by three classes: (1) External/Antisocial Risk Factors, (2) Mental Health Risk Factors, and (3) No Pattern. These findings support the conceptualization that military suicide attempters and decedents represent a single population.     

When Does Soldier Patriotism or Nationalism Matter? The Role of Transformational Small‐Unit Leaders

Patriotism and nationalism, 2 sets of attitudes often associated with the military, are examined in relation to perceived combat readiness and intention to remain in military service. Transformational leadership served as an intervening variable in these relationships. Survey data obtained from a sample of Army National Guard soldiers (N = 415) were used to examine relationships. Among junior‐ranking enlisted soldiers, both patriotism and nationalism showed significant, positive associations with perceived combat readiness and intention to remain in military service. The structural equation model fit soldiers' nationalistic attitudes best, having a considerable indirect effect through transformational leadership on perceived combat readiness. Implications of nationalistic and patriotic attitudes combined with charismatic leaders to benefit soldier readiness and retention are discussed.     

Soldier Background and Postinvestigative Events Associated With Timing of Suicide Following Deployment of U.S. Army National Guard Soldiers

The present study examined the timing of suicide and its associated soldier background and postinvestigative events among deployed Army National Guard (ARNG) soldiers from calendar years 2007 through 2014. Suicide deaths were nearly equally distributed between soldiers who had been deployed and those who had not. Among those deployed, however, suicides occurred mostly 1 year or more after having returned from deployment. Soldier background and postsuicide investigative events were associated with the timing of suicide. Having more years of military service, more previous deployments, and being married were associated with in-theater suicides. Soldiers younger in age (17–24 years), single, nonprior service, and lower in rank, in addition to having parent-family conflicts, full-time employment problems, and military transition problems were associated with suicides that had occurred 1–120 days and 120–365 days since return from deployment. Soldiers aged (24–29 years), married, and higher in rank, along with more reported problems including past behavioral health conditions, postdeployment behavior health referrals, criminal behaviors, and military performance were associated with suicides that had occurred 1 year or more after return. Findings likely represent time periods of suicide vulnerability for identifiable groups of soldiers, based on soldier background and events surrounding the suicide. Practical and theoretical implications of the findings are discussed.     

中国军人心理健康状况的横断历史研究：1990~2007

使用1990~2007年18年间的142组数据, 以横断历史研究的元分析方法, 研究了108736位中国军人的心理健康状况随年代的变化趋势。这些数据来自94篇相关研究报告, 这些研究都使用了90项症状自评量表(SCL-90)作为心理健康的测评工具。结果发现：(1)世纪之交的18年间, 中国军人的心理健康越来越好; (2)18年间, 中国军人在“人际敏感”方面变化最大, 而在“躯体化”方面变化最小; (3)18年间, 中国军人在“恐怖”方面最没问题, 而在“强迫症状”和“人际敏感”方面所表现出的问题一直突出; (4)中国独生子女军人(N = 1944)的心理健康状况低于非独生子女军人(N = 2649); (5)中国城市籍军人(N = 7808)的心理健康状况低于农村籍军人(N = 11459); (6)中国高中学历军人(N = 10189)的心理健康状况低于初中(N = 8407)和大学学历(N = 863)的军人。     

Factors Associated with Achieving Complete Mental Health among Individuals with Lifetime Suicidal Ideation

The objective of this study was to identify factors associated with complete mental health among Canadians who had ever seriously considered suicide. Data for this study were obtained from Statistics Canada's 2012 Canadian Community Health Survey–Mental Health (N = 2,844). The outcome variable examined in this study was complete mental health and was analyzed using binary logistic regression. Of the 2,844 respondents with lifetime suicidal ideation, 1,088 (38.2%) had complete mental health (i.e., had flourishing mental health, no mental illness, and no suicidal ideation in the past 12 months). Those who had a confidant were seven times more likely to have complete mental health. Other factors associated with achieving complete mental health among formerly suicidal respondents include being older, being a woman, having higher income, use of religious coping, and never previously having a mental illness. Considering the importance of these protective factors in formulating public health policies will allow for a more wide‐reaching approach to suicide prevention.     

Deployment trauma and seeking treatment for PTSD in US soldiers

Many service members in need of mental health treatment do not seek such treatment. This study investigated the frequency of Army soldiers’ exposure to specific types of deployment stressors and whether different event-types were associated with willingness to seek and actual receipt of treatment. Male soldiers who were married (n = 600) completed online surveys that assessed posttraumatic stress disorder (PTSD), willingness to seek treatment for PTSD, actual receipt of PTSD treatment, and the frequency of exposure to 4 types of potentially traumatizing warzone experiences: committing a moral injury, observing a moral injury, threats to life, and traumatic loss. Soldiers who reported greater exposure to moral injury experiences (committed or observed) were less likely to be willing to seek treatment, regardless of PTSD symptom severity. Although exposure to moral injury did not differentiate actual treatment receipt, soldiers who endorsed loss were more likely to have received treatment, regardless of PTSD symptom severity. These results suggest that the types of trauma experienced during deployment may be a factor in postdeployment treatment-seeking attitudes and behaviors.     

The 24 hours before hospitalization: factors related to suicide attempting

Fifty-nine psychiatric inpatients were interviewed concerning the psychological and environmental events that occurred in the 24 hours prior to their hospitalization. Independent raters then performed a content evaluation of these accounts, allowing for comparisons among patients admitted for a suicide attempt, suicide ideation, or non-suicide-related complaints. Results showed that suicide attempters were more likely to have used alcohol or marijuana and less likely to have contacted a health care professional than suicide ideators, even when past history of suicide behavior was controlled for. Suicide ideators were more likely to have contacted a mental health professional. Implications for suicide risk assessment and intervention are discussed.     

An Evaluation of Unit Replacement on Unit Cohesion and Individual Morale in the U. S. Army All-Volunteer Force

In 1981, the U.S. Army initiated a new personnel replacement system, called the Unit Replacement System, in selected units. The new training and assignment policy was aimed at improving the perceived lack of group cohesion and low level of morale in U.S. Army units. Survey data were collected from junior-ranking enlisted soldiers in both Individual Replace- ment (IR) and Unit Replacement (UR) units to assess the effects of UR on soldiers' perceptions about interpersonal relations and combat readiness. Surveys were administered during a Zyear period (1986-1988) in three waves 6 to 8 months apart. The purpose of this article is to report the initial findings of this evaluation based on the first three waves of survey data. Company mean scores on measures of cohesion and morale were significantly higher for UR units than for IR units at Time 1, even when controlling for individual soldier and unit characteristics. However, the higher UR-unit scores decreased over time. The only remaining statistical difference between IR and UR units at Time 3 was observed on the measure of Off-Duty Social Associations. The difference on this scale (an important predictor of willingness to go to war with other unit members) was even greater in UR units in which noncommis- sioned officers (NCOs) and officers were perceived as having higher concern for junior-ranking enlisted soliders (Concerned Leadership). Moreover, UR units having higher levels of Concerned Leadership had less of a decrease on the other cohesion and morale measures between Time 1 and Time 2, especially on perceptions of the closeness and tightness of affective ties among the junior-ranking enlisted soldiers (Horizontal Bonding).     

Differentiating Suicide Ideators from Attempters: Violence—A Research Note

Which factors distinguish suicide attempters from suicide ideators is a relatively neglected question in suicidology. Data from the 2001 Youth Risk Behavior Survey, encompassing 1,439 youth suicide ideators and 1,097 attempters, was used to explore which factors best differentiate suicide attempters from ideators, with a focus on violence involvement. Measures of violence include the contexts of fights, dating, and weapons carrying. Controls were incorporated for psychiatric disorders, risky sexual behavior, school integration, and demographics. Controlling for the other variables, violence differentiated attempts from ideation: fighting (OR = 2.18) and weapon carrying (OR = 1.13). Psychiatric factors that predicted attempts over ideation included major depression (OR = 1.86), use of cocaine (OR = 2.34), and having a suicide plan (OR = 2.69), while demographic factors included gender, age, residence in the Midwest, and Hispanic, African American, or Asian ethnicity. A supplementary analysis (N = 11,546) determined that violence also helped to differentiate suicide ideators from nonsuicidal youth. Four factors (including violence involvement, eating disorders, and gender consistently) differentiated both between suicide attempts and ideation, and also between suicide ideators and nonsuicidal youth. The link between violence involvement and suicidality is interpreted in terms of the capability for suicide from the interpersonal theory of suicide.     

Behavioral Health Adjustment in Reserve Component Soldiers During a Noncombat Deployment to Africa

This study benchmarked rates of mental health problems, adjustment difficulties, and perceptions of unit climate among 505 U.S. soldiers (primarily National Guard) deployed to the Horn of Africa in 2012. In addition, the study examined whether differences across these outcomes exist between combat veterans (n = 239) and noncombat veterans (n = 242). Rates of mental health problems among soldiers on this noncombat deployment were lower than rates typically found among soldiers on combat deployments. Furthermore, soldiers without previous combat experience had lower rates of mental health problems and aggression than combat veterans. Similar differences were evident when adjustment difficulties and unit climate variables were compared. Although combat veterans could be valuable in training new soldiers, the results of this study indicate that combat veterans may need more targeted resources to facilitate their adjustment if they are to be optimally utilized.     

Precipitating Circumstances of Suicide among Active Duty U.S. Army Personnel Versus U.S. Civilians, 2005–2010

To help understand suicide among soldiers, we compared suicide events between active duty U.S. Army versus civilian decedents to identify differences and inform military prevention efforts. We linked 141 Army suicide records from 2005 to 2010 to National Violent Death Reporting System (NVDRS) data. We described the decedents’ military background and compared their precipitators of death captured in NVDRS to those of demographically matched civilian suicide decedents. Both groups commonly had mental health and intimate partner precipitating circumstances, but soldier decedents less commonly disclosed suicide intent.     

In this together: Psychological wellbeing of foreign workers in the United Arab Emirates during the COVID-19 pandemic

The COVID-19 pandemic and the associated infection prevention and control measures (e.g. quarantine, lockdown and isolation), have had an adverse impact on mental health. To date, the mental health status and challenges of foreign workers during the pandemic have been neglected in the literature. This cross-sectional web-based survey assessed levels of post-traumatic stress, depression, anxiety and insomnia among an international sample of foreign workers (n = 319) resident in the United Arab Emirates (UAE). The majority of participants were female (76%), European (69%) and highly educated (83% had a bachelor's or higher degree). Results indicate high rates of post-traumatic stress, depression, anxiety, and insomnia, especially among women, younger individuals, and those with a previous diagnosis of a psychological disorder. Additionally, foreign workers' perceptions of pandemic severity in their home nations (mild, moderate, severe) were positively correlated with their symptom levels of depression, anxiety and insomnia. Overall, these findings may help inform future public mental health strategy and pandemic preparedness plans with reference to safeguarding the psychological wellbeing of foreign workers.     

Predictors of Recent Mental Health Service Use in a Medical Population: Implications for Integrated Care

This study investigated the relationship between physical and mental health and psychosocial variables and recent (within the last 12 months) mental health service use among 240 medical patients recruited from general and specialty outpatient clinics at an academic medical center. Results indicated 43.3% of the participants had recently received mental health services in the form of psychotropic medication (75%), psychotherapy (2%), or a combination of these treatments (20.2%). Among patients with moderate to severe symptoms of anxiety or depression, approximately two-thirds were receiving mental health treatment. Moreover, four variables (healthcare provider referral for mental health services, perceived need for mental health services, prior use of mental health services, and frequency of medical appointments) were significant unique predictors of recent mental health service use. This suggests collaborative/integrated medical care may increase needed mental health service use.     

Sexual assault history and use of health and mental health services

A history of sexual assault may be associated with increased current use of mental health and medical services because of the psychologically and physically disruptive consequences of assault. To test this hypothesis, we estimated rates of mental health and medical services use among 2560 randomly selected community residents, 343 of whom had been sexually assaulted. Sexual assault was associated with seeking both forms of care. Controls for demographic variables, psychiatric diagnosis, health status, and insurance suggested that assault increases use indirectly, through poor mental and physical health. Uninsured, assaulted respondents were especially likely to consult medical providers. Respondents assaulted during childhood were particularly likely to seek mental health care. Assault was more common among mental health service users than nonusers, and among women using medical services compared to female nonpatients. The high prevalence of assault among service users underscores the need for providers to recognize and treat sexual assault-related problems.     

Case–contrast study about parent–infant interaction in a Brazilian sample of siblings of children with autism spectrum disorders

Siblings of children with autism spectrum disorders (ASD) present greater susceptibility to developmental problems, in comparison with siblings of typically developing children. The greater prevalence of mental health disorders among parents of children with ASD increases younger siblings’ vulnerability to emotional problems. The aim of this study is to compare the interaction between carers and babies aged 2 to 26 months (M = 11.7, SD = 6.9) who are siblings of children with ASD (ASD dyads) with the interaction of dyads of siblings of typically developing children (TD dyads). The protocol of Clinical Indicators of Risk for Child Development and the Coding Interactive Behaviour measures were used to evaluate interaction. ASD dyads presented higher scores of constriction in their interaction, P = .024, with babies presenting higher scores of withdrawal behavior, P = .003, and carers presenting higher scores of depressive mood, P = .008, when compared to TD dyads. The ASD dyads have interactive impairments more frequently than do the TD dyads.