- Lead author Dr. Robert Ursano reports rates and predictors of suicide attempts in U.S. Army during the wars in Afghanistan and Iraq.
- Predicting Suicides After Psychiatric Hospitalization in US Army Soldiers (KMOX - Radio)
- Author Interviews: Dr. Ron Kessler talks about predicting suicide after hospitalization (JAMA Psychiatry - Audio interview)
- Spike in Soldier Suicide Rates Leads to Prediction of Post-Hospitalization Suicides (Medical Daily)
The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is the largest study of mental health risk and resilience ever conducted among military personnel. The interdisciplinary research team is led by Co-Principal Investigators Robert J. Ursano, MD, of the Uniformed Services University of the Health Sciences (USUHS) and Murray B. Stein, MD, MPH, of the University of California, San Diego (UCSD). Army STARRS investigators are using five separate study components – the Historical Administrative Data Study, New Soldier Study, All Army Study, Soldier Health Outcomes Study and Special Studies – to identify factors that help protect a Soldier’s mental health and factors that put a Soldier’s mental health at risk. Army STARRS ran through June 2015. The researchers reported the findings to senior Army leadership as the findings became available, so that the Army had the ability to apply them to its ongoing health promotion, risk reduction, and suicide prevention efforts.
The length and scope of Army STARRS means the study generates a vast amount of information. It also allows investigators to focus on periods in a military career that are known to be high risk for psychological problems. The information gathered from volunteer participants throughout the study will help researchers identify both potential risk factors and potential “protective” factors. Because promoting mental health and reducing suicide risk are important for all Americans, the findings from Army STARRS will benefit not only servicemembers but the nation as a whole.
Promoting mental health and reducing suicide risk are important goals for Americans from all walks of life. Historically, the suicide rate among Army personnel has been lower than that of the civilian population. In 2004, however, the suicide rate among Soldiers began rising, reaching record levels in 2007 and again in 2008 and 2009. The situation prompted the Army to engage the National Institute of Mental Health (NIMH) in helping to find a team of academic scientists who could creatively and comprehensively address this issue. Army STARRS is a direct response to the Army’s request that NIMH enlist the most promising scientific experts to develop and implement a research program designed to better understand psychological resilience, mental health, and risk for self-harm among Soldiers.
- Study Components
The Army STARRS research team designed and implemented five study components: the Historical Administrative Data Study, New Soldier Study, All Army Study, Soldier Health Outcomes Study and Special Studies.
The Historical Administrative Data Study
In the early stages of Army STARRS, investigators launched the Historical Administrative Data Study. This component involves examining more than a billion lines of data from the de-identified historical health and administrative records of more than 1.6 million Soldiers who were on active duty between 2004 and 2009. Researchers hope to detect risk and protective factors related to psychological resilience, mental health, risky behaviors, and suicide.
The All Army Study
In January 2011, the research team began using surveys to gather information directly from active duty Soldiers (including mobilized Army Reserve and Army National Guard) who volunteered to participate in the All Army Study. This component of Army STARRS assesses Soldiers' psychological and physical health; events encountered during training, combat, and non-combat operations; and life and work experiences across all phases of Army service. Researchers are using this information to determine how these various factors affect Soldiers’ psychological resilience, mental health, and risk for self-harm.
The New Soldier Study
Army STARRS researchers also invited new Soldiers just entering the Army to volunteer for the New Soldier Study. Using a survey, neurcognitive tests and blood collection, researchers are assessing the health, personal characteristics, and prior experiences of new Soldiers as they begin their Army service. The New Soldier Study began in February 2011.
The Soldier Health Outcomes Study (SHOS-A & B)
This component involves two case-control studies. Each study compares participants who have exhibited suicidal behavior (cases) with those who have not (controls). SHOS-A focuses on Soldiers who attempted suicide and were admitted to a medical treatment facility. SHOS-B focuses on Soldiers who committed suicide and involves interviews with next-of-kin and Army supervisors. Both studies will attempt to identify characteristics, events, experiences and exposures that predict negative (or positive) health and behavior outcomes. SHOS-A began in November 2011, SHOS-B began in March 2012.
For more information about SHOS-B, visit this page: SHOS-B Information Page
- The Pre/Post Deployment Study is designed to study the effects of deployment to a combat zone. Researchers are looking at the relationship between physical and biological changes and the risk and resilience of suicidality and related mental health disorders. Beginning in January 2012, some units of Soldiers preparing to deploy to Afghanistan had an opportunity to complete a questionnaire and donate blood. These units also had three opportunities to participate in follow-up research when they returned to the United States. The Pre/Post Deployment Study, like all Army STARRS studies, is strictly voluntary.
- The Clinical Reappraisal Study involved in-depth clinical interviews with a variety of Soldier volunteers. Researchers used the results to calibrate and validate the diagnostic accuracy of measures used in Army STARRS questionnaires. The Clinical Reappraisal Study began in March 2012.
Privacy is a top priority in every study component.Soldiers' personal identifying information is strictly confidential. A participant's answers are never shared with anyone in the Army unless the Soldier indicates that s/he is in imminent danger of self-harm or harming someone else. Some Soldiers participate once, while others may be asked to participate over a longer period of time. This approach allows researchers to identify factors that predict which individuals may experience mental health challenges.
- The Research Team
NIMH awarded a grant to a team of renowned experts who designed and conducted Army STARRS. The team included members from the Uniformed Services University of the Health Sciences (USUHS), the University of California, San Diego, the University of Michigan, and the Harvard Medical School. Collaborating scientists from NIMH and consulting scientists from the Army assisted. Additional Army and NIMH program staff contributed to the oversight of the study. This research team brought together international leaders in psychiatry, military health, health and behavior surveys, epidemiology, suicide, and genetic and neurobiological factors involved in psychological health.
The interdisciplinary team was led by Co-Principal Investigators:
- Robert J. Ursano, M.D., of the Uniformed Services University of the Health Sciences and
- Murray Stein, M.D., M.P.H., of the University of California, San Diego.
The study's site investigators were:
- Steven G. Heeringa, Ph.D., University of Michigan
- Ronald C. Kessler, Ph.D., Harvard Medical School
NIMH collaborating scientists were:
- Lisa J. Colpe, Ph.D., M.P.H., NIMH
- Michael Schoenbaum, Ph.D., NIMH
NIMH and Army oversight and leadership included:
- Scott Ludtke, GS-15, Acting Army Executive Director, Army STARRS
- Kevin Quinn, Ph.D., NIMH Study Director, Army STARRS
- James Churchill, Ph.D., NIMH Program Officer, Army STARRS
- COL Steven Cersovsky, M.D., M.P.H., Preventive Medicine Consultant, Army STARRS
- Kenneth Cox, M.D., M.P.H., Medical Informatics Consultant, Army STARRS
Taken together, the depth and breadth of the research team, the tremendous scale of the project, and the timely reporting of the research findings make Army STARRS truly groundbreaking research that will benefit members of the armed forces and the nation for decades to come.
For More Information
For additional information, please visit the Army STARRS home page. You may also e-mail the research team. Soldiers with questions about participating in Army STARRS can contact the team at ArmySTARRS@umich.edu.