A: Your privacy is extremely important. Because this research explores some very personal topics, your answers will be held in the strictest confidence. Any information that could be used to identify you will be removed from your responses and other study information. Your responses will be combined with those from other study participants and researchers will analyze the combined information to find ways to improve overall mental health. Your answers will never be shared with anyone in your chain of command unless you indicate that you are in imminent danger of harming yourself or someone else.

A: Researchers are interested in learning how Soldiers are doing at different times during their service. The research team would like to collect information such as promotions and career track information, duty assignments, medical information, training, health assessment surveys, and disciplinary actions from the Army/DoD. Researchers will add this information to the answers on the questionnaire. Your name will not be included in this combined data file. By putting this information together, researchers will be able to see how Soldiers’ physical and emotional health changes before, during, and after deployments. There is no risk to you in doing this, because this is information that the Army already has, but researchers do need your permission to collect your Army information and add it to questionnaire answers. Again, your name will never be connected to the questionnaire answers or the Army records that researchers obtain. Your answers will never be shared with anyone in your chain of command unless you indicate that you are in imminent danger of harming yourself or someone else.

A: Results will only be reported for groups of people, not individuals. Other steps researchers will take to protect your confidentiality include:

• Researchers replace your name with a study number.
• Researchers only use data with study numbers.
• Researchers do not allow data access to anyone outside the Army STARRS research team – this includes Army personnel.
• Researchers adhere to very strict data security procedures.
• Results will be reported for groups only.

A: NIMH and the Army have multiple safeguards at all levels of the study and in all aspects of the study. This is to protect the confidentiality of participating Soldiers. Here are some examples of these safeguards:

• Informed consent – Participating in Army STARRS is voluntary. Researchers will give servicemembers information about the study and about confidentiality protections. A Soldier will be able to make an informed decision about whether or not to participate.
• Information that could identify individual Soldiers will be removed from survey responses and other study information. Data from participants will be combined with data from other study participants. Researchers will analyze and report on the combined data, which will preserve Soldiers’ anonymity.
• Certificates of Confidentiality—Certificates of Confidentiality are used in Army STARRS to protect identifiable research information from forced or compelled disclosure. They allow the researchers to refuse to release information that would identify servicemembers in civil, criminal, administrative, legislative, or other proceedings. Certificates of Confidentiality are often used in studies collecting information that could have adverse consequences for participants. Certificates of Confidentiality protect researchers from having to disclose information that would identify research subjects. The Certificates of Confidentiality help reduce risks to subjects by adding more protection for keeping private information confidential.
  You should understand that a Certificate of Confidentiality does not prevent you or a member of your family from voluntarily releasing information about yourself or your involvement in this research. If an insurer, employer, or other person obtains your written consent to receive research information, then the researchers may not use the Certificate to withhold that information.
• Institutional Review Boards (IRB)—IRBs are special review groups. IRBs protect the interests of people who participate in biomedical or behavioral research. The IRB at the University of Michigan handles study reviews on behalf of the research team. The IRB at the Uniformed Services University of the Health Sciences handles reviews on behalf of the Army.

A: The Army STARRS research team will look at your answers without your name or any information about you attached. Results will only be reported for groups of people, not individuals. Your answers will never be shared with your chain of command unless you indicate that you are in imminent danger of harming yourself or someone else.

A: To help your fellow Soldiers. You may not benefit personally from filling out a questionnaire, but participating in this study can help the Army understand how to help other Soldiers, their Families, and their friends stay healthy after going through experiences that can be stressful.

A: No, joining Army STARRS is strictly voluntary. If researchers invite you to be part of the study, you can decide whether or not to do so. Nothing will happen to you if you decide not to participate. If you do fill out the questionnaire, you can skip any question that you don’t want to answer.

Your participation is very important because the greater the number of Soldiers who participate in the study, the more successful researchers will be in identifying the factors that affect Soldiers’ well-being.

A: If your unit is selected in the future, you will be able to participate at that time.

A: For some people, answering questions about stressful experiences can make them anxious or upset. Other people find it helpful to answer questions about these experiences. If the questions upset you, you can stop at any time. It is very unlikely, but if you were to become so upset that you needed medical treatment, the Army would provide it. The researchers will not provide the treatment or compensation for services. There will be no follow-up intervention or diagnoses made from your questionnaire responses.

A: The findings from this study may impact Servicemembers, their Families, and the Nation as a whole. Researchers will report their findings as they become available so that they may be applied to ongoing health promotion, risk reduction, and suicide prevention efforts. In addition, researchers have quarterly briefings with Army leadership to discuss their progress.

A: Most Soldiers will complete the survey on a laptop. In some smaller, or OCONUS locations, it is more practical for the research team to use paper-and-pencil surveys.

A: No, the computer-based surveys are administered in a classroom setting on secure laptops that feed into a secure, wireless server owned by the University of Michigan. The survey is not set up on the Internet. The paper-and-pencil surveys will be distributed and collected in a secure, group setting.

A: While Army STARRS is a large study, it cannot include all groups (i.e. non-mobilized ARNG, veterans, etc.). Researchers include activated Guard and Reserve units as part of the current active Army force.

A: The research team will be contacting some families who have lost a loved one to a sudden death—one not caused by a physical illness.

A: Yes. Researchers plan to reach Soldiers in all phases of Army service.

A: Yes. Researchers plan to reach Soldiers in all phases of Army service.

A: The National Institute of Mental Health (NIMH) and the U.S. Army are partnering to conduct the Army Study To Assess Risk and Resilience in Servicemembers (Army STARRS), the largest study of mental health risk and resilience factors ever conducted among military personnel. The purpose of Army STARRS is to identify—as quickly as possible—things that protect or pose risks to Soldiers' emotional well-being and overall mental health so that the Army may use the information in its ongoing health promotion, risk reduction, and suicide prevention efforts.
Army STARRS researchers want to learn how Soldiers build and keep up strong physical and emotional health. They ask about current and past health status, experiences, and attitudes. Researchers hope to help the Army improve programs that help Soldiers stay healthy after experiences that some people find stressful.

A: There are two main reasons Army STARRS is a 5-year study.

First, suicide is a tragic yet rare event. In the civilian population (the part that matches the characteristics of the Army), approximately 19 suicides per year occur in every 100,000 people. The rate in the Army has traditionally been below the civilian rate, but even with the recent rise in suicides, the Army reports there are approximately 22 suicides for every 100,000 Soldiers. It takes time to gather the amount of data needed to study a complex issue that is also a rare phenomenon.

Second, Army STARRS is similar to the Framingham Heart Study in which researchers followed the citizens of Framingham, Massachusetts for more than 50 years gathering data about heart disease. Before Framingham, no one knew that smoking or cholesterol influenced heart health. Conventional wisdom held that high blood pressure was a necessary part of aging. Today, everyone knows that these three factors have a strong influence on a person’s risk of heart attack. Army STARRS’ goal is to find similar risk and protective factors for suicide but to accomplish that goal within five years. To achieve that goal, the research team designed and deployed multiple studies to run in parallel rather than rolling them out one by one. Still, it took several years of careful work to accomplish this. The many components of Army STARRS as well as the number of Soldiers enrolled (approximately 100,000 by the end of the study) will help researchers gather a vast amount of information in a short time. So, viewed from this perspective, Army STARRS is a study with an extremely short (not long) timeline!

Army STARRS is a very complex study that looks at historical data from 1.6 million Soldiers as well as current data gathered from Soldier surveys, blood, and neurocognitive tests. These data are collected from new Soldiers just beginning their Army careers as well as established Soldiers stationed all over the world—including Soldiers traveling into and out of Afghanistan. The five-year Army STARRS clock began with researchers designing the study and working with many, Army Commands, agencies, experts and leaders on logistics and implementation. The clock continues as the research team collects confidential information from 100,000 Soldiers and as the team analyzes this wealth of data. In July 2012, Army STARRS entered its fourth year.

It has taken time for the researchers to carefully put together all these different but important aspects of the study but Army leaders will not have to wait 5 years to hear the results. The research team has held, and will continue to hold, quarterly progress reports so Army leaders hear about preliminary results as soon as they are available. Finalized/verified findings will be available to all via publications in peer-reviewed scientific journals over the next few years.

A: Researchers are surveying thousands of Active Duty Soldiers. The information gathered describes the Soldiers' psychological and physical health, exposure to events, attitudes, social support, leadership and unit climate, training and knowledge, employment and economic status, family history and other potentially relevant areas. Additionally, biological specimens such as blood may be collected for genetic and neurobiological studies.
Researchers also seek information from new Soldiers entering the Army. Some Soldiers may be followed over the study period. The information gathered will help researchers find characteristics, events, experiences, and exposures that may predict who will experience mental-health challenges.

A: Suicide is a relatively rare event (in statistical terms, for instance, there were 115 confirmed suicide deaths among Army Soldiers in 2007, a rate of 18.1/100,000 Soldiers). Thus very large samples are required for in-depth scientific analysis, which this study will provide.

A: Although Army STARRS will run through 2014, research findings are reported as they become available so the Army and others may use them in ongoing health promotion, risk reduction, and suicide prevention efforts.

A: Mental health problems and suicide are issues that affect Americans from all walks of life, yet, historically, the suicide rate among Army personnel has been below that of the civilian population. Since 2002, however, the suicide rate among Soldiers has risen significantly. The rate reached record levels in 2007 and again in 2008 and 2009. These numbers caused the Army to forge a partnership with the National Institute of Mental Health (NIMH) in 2008 and award a grant in 2009 to address this issue.
Army STARRS is a direct response to the Army's request to NIMH to enlist the most promising scientific approaches for addressing Soldiers' overall health, well-being, and the prevention of self-harm.

A: The Army sought out NIMH as a partner for this study because NIMH is the premier mental health research organization in the United States and NIHM is well positioned to give the most up-to-date scientific research information on Soldiers' overall health, well-being, and the prevention of self-harm.
NIMH has assembled a group of renowned experts to carry out this research including teams from the Uniformed Services University of the Health Sciences (USUHS), University of California, San Diego; University of Michigan; Harvard Medical School; and NIMH. Additional Army and NIMH program staff contribute to the oversight and implementation of the study.

A: The research team brings together international leaders in military health, health and behavior surveys, epidemiology, suicide, and genetic and neurobiological factors involved in psychological health and suicidal behavior.
The interdisciplinary team is led by:

• Robert J. Ursano, MD, Uniformed Services University of the Health Sciences and
• Murray Stein, MD, MPH, University of California, San Diego.

The study’s other investigators are:

• Steven G. Heeringa, PhD, University of Michigan
• Ronald C. Kessler, PhD, Harvard Medical School

NIMH Scientists include:

• Lisa J. Colpe, PhD, MPH, NIMH
• Michael Schoenbaum, PhD, NIMH

NIMH and Army oversight and implementation leadership include:

• Kevin Quinn, PhD, NIMH Study Director, Army STARRS
• Scott Ludtke, GS-15, Acting Army Executive Director, Army STARRS
• James Churchill, PhD, NIMH Program Official, Army STARRS
• COL Steven Cersovsky, MD, MPH, Preventive Medicine Consultant, Army STARRS
• Kenneth Cox, MD, MPH, Medical Informatics Consultant, Army STARRS

A: The Army STARRS project will look at many risk and protective factors - those that are already known to affect mental health risk and suicide as well as many that are suspected of contributing to well-being, mental illness and self-harm. Some examples of factors that Army STARRS will consider are:

• Stress of all kinds, past and present (e.g., interpersonal relationships, legal and economic difficulties, family illness)
• Deployments, exposure to combat and trauma, unit cohesion and morale, injuries and bereavement
• Exposure to trauma outside of deployment
• Strategies for coping with stress and adversity
• Family and personal history (e.g., personal achievements, family stability, childhood experiences, mental illness, substance use patterns)
• Personality traits and temperament (e.g., interpersonal skills, degree of openness; self-discipline, cooperativeness)
• Demographic characteristics (e.g., sex, age, ethnicity, educational level)
• Social connections and social support
• Current and past health status.

A: The overall model for this study is the Framingham Heart Study, Framingham Heart Study which focused on the causes of heart disease in the 1950s. The Framingham Heart Study made it possible to generate and study new hypotheses about the role of risk factors in causing illness.
Army STARRS works with Soldiers from all phases of Army service. It has both retrospective components-involving more than a billion de-identified health and administrative records and prospective components, in which soldiers are followed over time.

A: Yes, Army STARRS is made up of four main components as well as several special studies:

• Historical Administrative Data Study (HADS)
  The Historical Administrative Data Study analyzes existing Army data to identify risk and protective factors related to psychological resilience, mental health, risky behaviors and suicide. The Army removes all personal identifiers (such as name and Social Security Number) before sharing existing data with the Army STARRS research team.
• New Soldier Study (NSS)
  The New Soldier Study collects information to assess the health, personal characteristics, and prior experiences of new Soldiers as they begin their Army service. The NSS completed data collection in November 2012.
• All Army Study (AAS)
  In the All Army Study, researchers assess 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. This information will be used to determine how these factors affect Soldiers’ psychological resilience, mental health, and risk for self-harm. Army Reserve and National Guard Soldiers will be part of the AAS. The All Army Study completed data collection in March 2013.
• Soldier Health Outcomes Study (SHOS)
  The Soldier Health Outcomes Study is comprised of two case-control studies of participants who have exhibited suicidal behavior compared with those who have not. This component will attempt to identify characteristics, events, experiences, and exposures that predict negative (or positive) health and behavior outcomes.
• Special Studies
• Pre /Post Deployment Study (PPDS)
  The Pre/Post Deployment Study examines the effects of deployment to a theater of combat operations and examines the relationship between observed physical and neurological changes and the risk/resilience of suicidality and related mental health disorders.
• Clinical Calibration Study (CCS)
  The Clinical Calibration Study will help determine the accuracy of classifying mental disorders assessed in AAS and NSS self-report questionnaires. The CCS completed data collection in November 2012.

A: Researchers have identified a wide variety of factors that may increase risk for suicide in civilian populations. However, very little is known about the strength of each factor or how multiple factors may combine to increase risk for different individuals in different situations and at different points in their lives. The Army STARRS project addresses a wide spectrum of both risk and protective factors – those that are already known to have an impact on mental health risk and suicide as well as many that are suspected of contributing to well-being, mental illness, and self-harm. Here are some examples of factors that Army STARRS considers:

• Stress of all kinds, past and present (e.g., interpersonal relationships, legal and economic difficulties, family illness)
• Deployments, exposure to combat and trauma, unit cohesion and morale, injuries and bereavement
• Exposure to trauma outside of deployment
• Strategies for coping with stress and adversity
• Family and personal history (e.g., personal achievements, family stability, childhood experiences, mental illness, substance use patterns)
• Personality traits and temperament (e.g., interpersonal skills, degree of openness, self-discipline, cooperativeness)
• Demographic characteristics (e.g., sex, age, ethnicity, educational level)
• Social connections and social support

The study will also investigate brain systems that underlie mental health and that may provide markers of suicide risk and psychological resilience. Executive function, for example, refers to the brain-based capacity for carrying out tasks that require focused attention, such as problem solving, decision-making and planning. The brain also coordinates the body’s stress response system. Previous studies have found the function of this system to be altered in people with mental disorders, and those who have experienced trauma or severe stress. Accordingly, various strategies will be used to assess the health of this system.
Genes shape brain activities involved with mood, reward and psychological traits and disorders. Previous studies have identified associations between specific genes and behavioral traits as well as vulnerability to disorders of mental health. Army STARRS will use state-of-the-art techniques to investigate candidate genes for links to suicide risk and psychological resilience.

A: Army STARRS is a five-year study and will run through 2014. Findings are reported as they become available so that the Army may apply them in ongoing health promotion, risk reduction, and suicide prevention efforts for Soldiers.

A: Research findings are reported as they become available so that they may be applied to the Army’s ongoing health promotion, risk reduction and suicide prevention efforts.

A: Call the National Suicide Prevention Lifeline:
1-800-273-TALK (1-800-273-8255)
Veterans can call the Lifeline number:
1-800-273-TALK (1-800-273-8255), and press "1" for
the Veterans’ Suicide Prevention Hotline.
En Español: 1-888-628-9454
Text the Military Crisis Line at 838255
For additional information visit the Resources page.