The plausibility of alternative data-generating mechanisms: Comment on and attempt at replication of Dishop (2022).

Dishop (see record 2022-78260-001) identifies the consensus emergence model (CEM) as a useful tool for future research on emergence but argues that autoregressive models with positive autoregressive effects are an important alternative data-generating mechanism that researchers need to rule out. Here, we acknowledge that alternative data-generating mechanisms are possibility for most, if not all, nonexperimental designs and appreciate Dishop's attempts to identify cases where the CEM could provide misleading results. However, in a series of independent simulations, we were unable to replicate two of three key analyses, and the results for the third analysis did not support the earlier conclusions. The discrepancies appear to originate from Dishop's simulation code and what appear to be inconsistent model specifications that neither simulate the models described in the article nor include notable positive autoregressive effects. We contribute to the wider literature by suggesting four key criteria that researchers can apply to evaluate the possibility of alternative data-generating mechanisms: Theory, parameter recovery, fit to real data, and context. Applied to autoregressive effects and emergence data, these criteria reveal that (a) theory in psychology would generally suggest negative instead of positive autoregressive effects for behavior, (b) it is challenging to recover true autoregressive parameters from simulated data, and (c) that real data sets across a number of different contexts show little to no evidence for autoregressive effects. Instead, our analyses suggest that CEM results are congruent with the temporal changes occurring within groups and that autoregressive effects do not lead to spurious CEM results. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Associations of active-duty mental health trajectories with post-military adjustment: Results from the STARRS Longitudinal Study.

BACKGROUND: Many servicemembers experience difficulties transitioning from military to civilian life. We examined whether changes in mental health observed during active duty were associated with indices of post-military adjustment. METHODS: Survey data from the multi-wave Army STARRS Pre/Post Deployment Study (PPDS; conducted 2012-2014) were linked to follow-up data from wave 1 of the STARRS Longitudinal Study (STARRS-LS1; conducted 2016-2018). Empirical Bayes estimates of intercepts and slopes of posttraumatic stress, problematic anger, and depressive symptoms during the PPDS were extracted from mixed-effects growth models and evaluated as predictors of life stress among 1080 participants who had separated or retired from the Army at STARRS-LS1; and of job satisfaction among 586 veterans who were employed at STARRS-LS1. RESULTS: Higher average levels and larger increases in posttraumatic stress, anger, and depression over the deployment period were each associated with increased stress and (in the case of anger and depression) reduced job satisfaction. Posttraumatic stress and anger slopes were associated with overall stress (b = 5.60, p < 0.01 and b = 15.64, p = 0.04, respectively) and relationship stress (b = 5.50, p = 0.01 and b = 22.86, p = 0.01, respectively) beyond the average levels of those symptoms. LIMITATIONS: Some transition-related difficulties may have resolved before outcome assessment; some measures were not previously validated. CONCLUSIONS: Larger increases in posttraumatic stress and anger over a deployment period were associated with increased stress after leaving the Army, even after controlling for average symptom levels during the same period. Monitoring changes in mental health during active duty may help identify personnel who need additional support to facilitate the military-to-civilian transition.

Wellness checks: Piloting a universal intervention for soldiers.

As part of an Army pilot program, mandatory annual wellness checks were initiated to introduce individuals to counseling and to support psychological resilience and thriving. The program was evaluated using a cross-sectional survey completed by 7,831 soldiers. Findings revealed that about half of soldiers who reported a wellness check rated the check at least moderately helpful in their professional and personal lives. Participants receiving a wellness check reported being more likely to report willingness to seek help if they were to have mental health problems and to report higher levels of resilience and thriving even after controlling for rank, age, education, months in the unit, and trait negative affect. Participants were also less likely to report stigma-related concerns compared to those who had not received a wellness check. Consistent with theory on the common factors in counseling and the contextual model of psychotherapy (Laska et al., 2014), feeling listened to and learning new skills partially mediated the association between perceived wellness check usefulness and study outcomes, although acquiring a new perspective about problems did not. While not a randomized trial, this evaluation suggests that wellness checks are associated with programmatic goals: improved attitudes toward care seeking, resilience, and thriving. Future work should consider ways to ensure counselors address therapeutic common factors and should use a randomized, longitudinal design. Study findings have implications for implementing programs like wellness checks for military personnel and others working in high-stress occupations like first responders. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effects of prior deployments and perceived resilience on anger trajectories of combat-deployed soldiers.

BACKGROUND: Problematic anger is frequently reported by soldiers who have deployed to combat zones. However, evidence is lacking with respect to how anger changes over a deployment cycle, and which factors prospectively influence change in anger among combat-deployed soldiers. METHODS: Reports of problematic anger were obtained from 7298 US Army soldiers who deployed to Afghanistan in 2012. A series of mixed-effects growth models estimated linear trajectories of anger over a period of 1-2 months before deployment to 9 months post-deployment, and evaluated the effects of pre-deployment factors (prior deployments and perceived resilience) on average levels and growth of problematic anger. RESULTS: A model with random intercepts and slopes provided the best fit, indicating heterogeneity in soldiers' levels and trajectories of anger. First-time deployers reported the lowest anger overall, but the most growth in anger over time. Soldiers with multiple prior deployments displayed the highest anger overall, which remained relatively stable over time. Higher pre-deployment resilience was associated with lower reports of anger, but its protective effect diminished over time. First- and second-time deployers reporting low resilience displayed different anger trajectories (stable v. decreasing, respectively). CONCLUSIONS: Change in anger from pre- to post-deployment varies based on pre-deployment factors. The observed differences in anger trajectories suggest that efforts to detect and reduce problematic anger should be tailored for first-time v. repeat deployers. Ongoing screening is needed even for soldiers reporting high resilience before deployment, as the protective effect of pre-deployment resilience on anger erodes over time.

Unit cohesion during deployment and post-deployment mental health: is cohesion an individual- or unit-level buffer for combat-exposed soldiers?

BACKGROUND: Unit cohesion may protect service member mental health by mitigating effects of combat exposure; however, questions remain about the origins of potential stress-buffering effects. We examined buffering effects associated with two forms of unit cohesion (peer-oriented horizontal cohesion and subordinate-leader vertical cohesion) defined as either individual-level or aggregated unit-level variables. METHODS: Longitudinal survey data from US Army soldiers who deployed to Afghanistan in 2012 were analyzed using mixed-effects regression. Models evaluated individual- and unit-level interaction effects of combat exposure and cohesion during deployment on symptoms of post-traumatic stress disorder (PTSD), depression, and suicidal ideation reported at 3 months post-deployment (model n's = 6684 to 6826). Given the small effective sample size (k = 89), the significance of unit-level interactions was evaluated at a 90% confidence level. RESULTS: At the individual-level, buffering effects of horizontal cohesion were found for PTSD symptoms [B = -0.11, 95% CI (-0.18 to -0.04), p < 0.01] and depressive symptoms [B = -0.06, 95% CI (-0.10 to -0.01), p < 0.05]; while a buffering effect of vertical cohesion was observed for PTSD symptoms only [B = -0.03, 95% CI (-0.06 to -0.0001), p < 0.05]. At the unit-level, buffering effects of horizontal (but not vertical) cohesion were observed for PTSD symptoms [B = -0.91, 90% CI (-1.70 to -0.11), p = 0.06], depressive symptoms [B = -0.83, 90% CI (-1.24 to -0.41), p < 0.01], and suicidal ideation [B = -0.32, 90% CI (-0.62 to -0.01), p = 0.08]. CONCLUSIONS: Policies and interventions that enhance horizontal cohesion may protect combat-exposed units against post-deployment mental health problems. Efforts to support individual soldiers who report low levels of horizontal or vertical cohesion may also yield mental health benefits.

Hitting the mark: The influence of emotional culture on resilient performance.

Previous research has established the role of positive emotional cultures such as companionate love and joy in predicting team performance. Building on this work, the present study analyzes the role of positive emotional culture variables as predictors of resilient performance by examining patterns of objective team performance in U.S. Army tank crews over time. We also broaden the emotional culture domain by investigating an action-oriented positive emotional culture of optimism and a negative emotional culture of anger. During a high-stakes international military training exercise, 55 U.S. Army tank crews (N = 175) completed a pre-qualification performance event, a final qualification performance event, and surveys at baseline and after both events. The positive emotional culture of optimism predicted a pattern of resilient performance defined as a rebound from poor pre-qualification performance. Emotional cultures of joy and optimism also directly predicted final performance, but neither the emotional culture of companionate love, nor the emotional culture of anger was a significant predictor. Results demonstrate the distinct nature of each of these emotional culture variables, and show that these variables differ from group trait affectivity and cohesion. Teams with a strong emotional culture of optimism were better positioned to rebound in the face of poor performance, suggesting that organizations that promote an optimistic culture develop more resilient teams. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sleep leadership in the army: A group randomized trial.

OBJECTIVES: Examine impact of training military leaders in sleep health on leaders and unit members. DESIGN: Following a baseline survey, two-person platoon leadership teams were randomly assigned by company to a training or waitlist control condition. After training, leadership teams completed a post-training survey. Six weeks later, leaders and unit members completed a final survey. SETTING: Classroom-style areas on a US military base. PARTICIPANTS: US soldiers (76 leaders and 448 unit members) from 39 platoons across 14 companies in a brigade combat team. INTERVENTION: One-hour training in sleep leadership. MEASUREMENTS: Leaders were surveyed about sleep knowledge, sleep attitudes, sleep training, sleep quantity, sleep quality and sleep problems. Unit members were surveyed about sleep leadership behaviors, sleep hours, sleep quality and sleep problems. RESULTS: Leaders rated the training highly and most knowledge and some attitudes about sleep improved from the baseline to post-training survey. Fewer leaders in the training condition reported sleep problems at follow-up than those in the waitlist control condition; there were no differences in sleep hours or sleep quality. More unit members with leaders in the training condition reported that their leaders engaged in sleep leadership behaviors at least sometimes and reported sleeping at least 7 hours/24 hours period than did unit members in the waitlist control condition; sleep quality and sleep problems did not differ by condition. CONCLUSIONS: Results suggest a simple training intervention targeting leaders may be able to shift sleep health and the cultural perspective on sleep across an organization.

Combat and Trajectories of Physical Health Functioning in U.S. Service Members.

INTRODUCTION: Previous research has demonstrated that different forms of mental health trajectories can be observed in service members, and that these trajectories are related to combat. However, limited research has examined this phenomenon in relation to physical health. This study aims to determine how combat exposure relates to trajectories of physical health functioning in U.S. service members. METHODS: This study included 11,950 Millennium Cohort Study participants who had an index deployment between 2001 and 2005. Self-reported physical health functioning was obtained 5 times between 2001 and 2016 (analyzed in 2017), and latent growth mixture modeling was used to identify longitudinal trajectories from these assessments. Differences in the shape and prevalence of physical health functioning trajectories were investigated in relation to participants' self-reported combat exposure over the index deployment. RESULTS: Five physical health functioning trajectories were identified (high-stable, delayed-declining, worsening, improving-worsening, and low-stable). Combat exposure did not influence the shape of trajectories (p=0.12) but did influence trajectory membership. Relative to personnel not exposed to combat, participants reporting combat exposure were more likely to be in the delayed-declining, worsening, and low-stable classes and less likely to be in the high-stable class. However, the high-stable class (i.e., the most optimal class) was the most common trajectory class among not exposed (73.0%) and combat-exposed (64.5%) personnel. CONCLUSIONS: Combat exposure during military deployment is associated with poorer physical health functioning trajectories spanning more than a decade of follow-up. However, even when exposed to combat, consistently high physical health functioning is the modal response.

Validity of Attention Bias Variability Indices for Posttraumatic Stress Disorder Research: Evidence From Patient Data.

Although initial findings indicated that threat-related attention bias variability (ABV), an index designed to capture dynamic shifts in threat-related attention over time, was positively correlated with the severity of posttraumatic stress disorder (PTSD) symptoms, a recent study relying on simulated data has raised questions regarding the validity and empirical utility of ABV. Specifically, the simulations suggested that core features of reaction time data distinct from threat-related attention bias, such as the reaction time standard deviation and mean, could explicate the reported elevated ABV among samples with PTSD. In the present study, we evaluated these suggestions in 95 PTSD-diagnosed participants. The results showed that ABV significantly and uniquely predicted PTSD symptom severity beyond the predictive value of core reaction time features, ΔR2 = .05-.23. Some of the predictions stemming from the simulated results were replicated, whereas others were not. Contrary to the conclusion drawn from the simulated data, the results from the current study suggest that ABV is a valid and replicable correlate of PTSD symptom severity.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) La validez de los índices de variabilidad del sesgo de atención para la investigación del TEPT: Evidencia sobre los datos de los pacientes VALIDEZ DE LA VARIABILIDAD DEL SESGO ATENCIONAL EN EL TEPT Aunque los hallazgos iniciales indicaron que la variabilidad del sesgo de atención (ABV en su sigla en inglés) relacionada con la amenaza, un índice diseñado para capturar cambios dinámicos en la atención relacionada con la amenaza a lo largo del tiempo, que se correlacionó positivamente con la gravedad de los síntomas del trastorno de estrés postraumático (TEPT), un estudio reciente basado en datos simulados ha planteado preguntas sobre la validez y la utilidad empírica del ABV. Específicamente, las simulaciones sugirieron que las características centrales de los datos del tiempo de reacción distintas del sesgo de atención relacionado con la amenaza, como la desviación estándar y la media del tiempo de reacción, podrían explicar el aumento del ABV reportado entre las muestras con el TEPT. En el presente estudio, evaluamos estas sugerencias en 95 participantes con diagnóstico del TEPT. Los resultados mostraron que ABV predijo de manera significativa y única la gravedad de los síntomas del TEPT más allá del valor predictivo de las características centrales del tiempo de reacción, ΔR2 = .05 - .23. Algunas de las predicciones derivadas de los resultados simulados se replicaron, mientras que otras no. Contrariamente a la conclusión extraída de los datos simulados, los resultados del estudio actual sugieren que la ABV es un correlato válido y replicable de la gravedad de los síntomas del TEPT.

Prospective associations of perceived unit cohesion with postdeployment mental health outcomes.

BACKGROUND: Prior investigations have found negative associations between military unit cohesion and posttraumatic stress disorder (PTSD); however, most relied on cross-sectional data and few examined relationships of unit cohesion to other mental disorders. This study evaluates prospective associations of perceived unit cohesion with a range of mental health outcomes following combat deployment. METHODS: U.S. Army soldiers were surveyed approximately 1-2 months before deployment to Afghanistan (T0); and 1 month (T1), 3 months (T2), and 9 months (T3) after return from deployment. Logistic regression was performed to estimate associations of perceived unit cohesion at T0 with risk of PTSD, major depressive episode (MDE), generalized anxiety disorder (GAD), alcohol or substance use disorder (AUD/SUD), and suicidal ideation at T2 or T3 among soldiers who completed all study assessments (N = 4,645). Models were adjusted for sociodemographic and Army service characteristics, predeployment history of the index outcome, and deployment stress exposure. RESULTS: Higher perceived unit cohesion at T0 was associated with lower risk of PTSD, MDE, GAD, AUD/SUD, and suicidal ideation at T2 or T3 (AORs = 0.72 to 0.85 per standard score increase in unit cohesion; P-values < 0.05). Models of incidence of mental disorders and suicidal ideation among soldiers without these problems predeployment yielded similar results, except that perceived unit cohesion was not associated with incident AUD/SUD. CONCLUSIONS: Soldiers who reported strong unit cohesion before deployment had lower risk of postdeployment mental disorders and suicidal ideation. Awareness of associations of perceived unit cohesion with postdeployment mental health may facilitate targeting of prevention programs.

Improving the measurement of group-level constructs by optimizing between-group differentiation.

The ability to detect differences between groups partially impacts how useful a group-level variable will be for subsequent analyses. Direct consensus and referent-shift consensus group-level constructs are often measured by aggregating group member responses to multi-item scales. We show that current measurement validation practice for these group-level constructs may not be optimized with respect to differentiating groups. More specifically, a 10-year review of multilevel articles in top journals reveals that multilevel measurement validation primarily relies on procedures designed for individual-level constructs. These procedures likely miss important information about how well each specific scale item differentiates between groups. We propose that group-level measurement validation be augmented with information about each scale item's ability to differentiate groups. Using previously published datasets, we demonstrate how ICC(1) estimates for each item of a scale provide unique information and can produce group-level scales with higher ICC(1) values that enhance predictive validity. We recommend that researchers supplement conventional measurement validation information with information about item-level ICC(1) values when developing or modifying scales to assess group-level constructs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Predeployment predictors of psychiatric disorder-symptoms and interpersonal violence during combat deployment.

BACKGROUND: Preventing suicides, mental disorders, and noncombat-related interpersonal violence during deployment are priorities of the US Army. We used predeployment survey and administrative data to develop actuarial models to identify soldiers at high risk of these outcomes during combat deployment. METHODS: The models were developed in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) Pre-Post Deployment Study, a panel study of soldiers deployed to Afghanistan in 2012-2013. Soldiers completed self-administered questionnaires before deployment and one (T1), three (T2), and nine months (T3) after deployment, and consented to administrative data linkage. Seven during-deployment outcomes were operationalized using the postdeployment surveys. Two overlapping samples were used because some outcomes were assessed at T1 (n = 7,048) and others at T2-T3 (n = 7,081). Ensemble machine learning was used to develop a model for each outcome from 273 predeployment predictors, which were compared to simple logistic regression models. RESULTS: The relative improvement in area under the receiver operating characteristic curve (AUC) obtained by machine learning compared to the logistic models ranged from 1.11 (major depression) to 1.83 (suicidality).The best-performing machine learning models were for major depression (AUC = 0.88), suicidality (0.86), and generalized anxiety disorder (0.85). Roughly 40% of these outcomes occurred among the 5% of soldiers with highest predicted risk. CONCLUSIONS: Actuarial models could be used to identify high risk soldiers either for exclusion from deployment or preventive interventions. However, the ultimate value of this approach depends on the associated costs, competing risks (e.g. stigma), and the effectiveness to-be-determined interventions.

Associations of Time-Related Deployment Variables With Risk of Suicide Attempt Among Soldiers: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

Importance: There has been limited systematic examination of whether risk of suicide attempt (SA) among US Army soldiers is associated with time-related deployment variables, such as time in service before first deployment, duration of first deployment, and dwell time (DT) (ie, length of time between deployments). Objective: To examine the associations of time-related deployment variables with subsequent SA among soldiers who had deployed twice. Design, Setting, and Participants: Using administrative data from January 1, 2004, through December 31, 2009, this longitudinal, retrospective cohort study identified person-month records of active-duty Regular Army enlisted soldiers who had served continuously in the US Army for at least 2 years and deployed exactly twice. The dates of analysis were March 1 to December 1, 2017. There were 593 soldiers with a medically documented SA during or after their second deployment. An equal-probability sample of control person-months was selected from other soldiers with exactly 2 deployments (n = 19 034). Logistic regression analyses examined the associations of time in service before first deployment, duration of first deployment, and DT with subsequent SA. Main Outcomes and Measures: Suicide attempts during or after second deployment were identified using US Department of Defense Suicide Event Report records and International Classification of Diseases, Ninth Revision, Clinical Modification E950 to E958 diagnostic codes. Independent variables were constructed from US Army personnel records. Results: Among 593 SA cases, most were male (513 [86.5%]), white non-Hispanic (392 [66.1%]), at least high school educated (477 [80.4%]), currently married (398 [67.1%]), and younger than 21 years when they entered the US Army (384 [64.8%]). In multivariable models adjusting for sociodemographics, service-related characteristics, and previous mental health diagnosis, odds of SA during or after second deployment were higher among soldiers whose first deployment occurred within the first 12 months of service vs after 12 months (odds ratio, 2.0; 95% CI, 1.6-2.4) and among those with a DT of 6 months or less vs longer than 6 months (odds ratio, 1.6; 95% CI, 1.2-2.0). Duration of first deployment was not associated with subsequent SA. Analysis of 2-way interactions indicated that the associations of early deployment and DT with SA risk were not modified by other characteristics. Multivariable population-attributable risk proportions were 14.2% for deployment within the first 12 months of service and 4.0% for DT of 6 months or less. Conclusions and Relevance: Time in service before first deployment and DT are modifiable risk factors for SA risk among soldiers.

Detecting and differentiating the direction of change and intervention effects in randomized trials.

Calls continue for randomized interventions in organizational settings. In many cases, however, practical constraints require researchers to use 2-wave randomized pretest-posttest control group designs. We discuss the importance of randomized trials for theory development with a focus on analytic options for 2-wave designs. Our discussion has implications for both designing studies and interpreting results. We review 23 published work and organizational health psychology intervention studies and find that a majority of studies featured a statistical model known to have low statistical power relative to other options. Furthermore, a majority of studies invoked terminology implying the direction of change without providing explicit statistical tests. To improve research practice, we detail statistical power differences in 3 commonly used statistical models and emphasize the distinction between (a) intervention effects and (b) the size and direction of change over time. We encourage researchers to provide inferential evidence for both types of information and show that only 1 of the 3 reviewed models provides information on the direction of change over time, but at a potential expense for statistical power to detect intervention effects. A reanalysis of data from a published work-family workplace intervention illustrates these nuances and supports recommendations for research practice. We conclude by providing recommendations. (PsycINFO Database Record

Coping Strategies as Moderators of the Association Between Combat Exposure and Posttraumatic Stress Disorder Symptoms.

The present research examined selected coping strategies as moderators of the relationship between combat exposure and posttraumatic stress disorder (PTSD) symptoms among service members who were deployed to Iraq (N = 2,023) and Afghanistan (N = 1,023). A three-factor model of coping was confirmed for both military operations: positive emotion-focused, self-blame, and prayer/spirituality. Positive emotion-focused coping was inversely associated with PTSD symptoms (r = -.14) and buffered service members from the negative effects of combat exposure in both Iraq (r2 = .01) and Afghanistan (r2 = .02). Self-blame coping was positively associated with PTSD symptoms in both samples (Iraq, r = .36; Afghanistan, r = .29) but only magnified the relationship between combat exposure and PTSD symptoms among service members in Iraq (r2 = .01) . These findings were replicated when controlling for unit cohesion and symptoms of depression. Prayer/spirituality coping was not significantly associated with PTSD symptoms, regardless of combat exposure. Discussion focuses on how specific positive emotion-focused coping strategies may be helpful for military personnel in combat operations given the uncontrollable and chaotic nature of the environment. Implications include providing training for deploying personnel that covers the use of these positive emotion-focused coping strategies and the potential problems with self-blame. Such training may also be suitable for other high-risk occupations in which employees face uncontrollable situations.

Predicting Sexual Assault Perpetration in the U.S. Army Using Administrative Data.

INTRODUCTION: The Department of Defense uses a universal prevention framework for sexual assault prevention, with each branch implementing its own branch-wide programs. Intensive interventions exist, but would be cost effective only if targeted at high-risk personnel. This study developed actuarial models to identify male U.S. Army soldiers at high risk of administratively recorded sexual assault perpetration. METHODS: This study investigated administratively recorded sexual assault perpetration among the 821,807 male Army soldiers serving 2004-2009. Administrative data were also used to operationalize the predictors. Penalized discrete-time (person-month) survival analysis (conducted in 2016) was used to select the smallest possible number of stable predictors to maximize number of sexual assaults among the 5% of soldiers with highest predicted risk of perpetration (top-ventile concentration of risk). Separate models were developed for assaults against non-family and intra-family adults and minors. RESULTS: There were 4,640 male soldiers found to be perpetrators against non-family adults, 1,384 against non-family minors, 380 against intra-family adults, and 335 against intra-family minors. Top-ventile concentration of risk was 16.2%-20.2% predicting perpetration against non-family adults and minors and 34.2%-65.1% against intra-family adults and minors. Final predictors consisted largely of measures of prior crime involvement and the presence and treatment of mental disorders. CONCLUSIONS: Administrative data can be used to develop actuarial models that identify a high proportion of sexual assault perpetrators. If a system is developed to consolidate administrative predictors routinely, then predictions could be generated periodically to identify those in need of preventive intervention. Whether this would be cost effective, though, would depend on intervention costs, effectiveness, and competing risks.

Risk of Suicide Attempt Among Soldiers in Army Units With a History of Suicide Attempts.

Importance: Mental health of soldiers is adversely affected by the death and injury of other unit members, but whether risk of suicide attempt is influenced by previous suicide attempts in a soldier's unit is unknown. Objective: To examine whether a soldier's risk of suicide attempt is influenced by previous suicide attempts in that soldier's unit. Design, Setting, and Participants: Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers (STARRS), this study identified person-month records for all active-duty, regular US Army, enlisted soldiers who attempted suicide from January 1, 2004, through December 31, 2009 (n = 9650), and an equal-probability sample of control person-months (n = 153 528). Data analysis was performed from August 8, 2016, to April 10, 2017. Main Outcomes and Measures: Logistic regression analyses examined the number of past-year suicide attempts in a soldier's unit as a predictor of subsequent suicide attempt, controlling for sociodemographic features, service-related characteristics, prior mental health diagnosis, and other unit variables, including suicide-, combat-, and unintentional injury-related unit deaths. The study also examined whether the influence of previous unit suicide attempts varied by military occupational specialty (MOS) and unit size. Results: Of the final analytic sample of 9512 enlisted soldiers who attempted suicide and 151 526 control person-months, most were male (86.4%), 29 years or younger (68.4%), younger than 21 years when entering the army (62.2%), white (59.8%), high school educated (76.6%), and currently married (54.8%). In adjusted models, soldiers were more likely to attempt suicide if 1 or more suicide attempts occurred in their unit during the past year (odds ratios [ORs], 1.4-2.3; P < .001), with odds increasing as the number of unit attempts increased. The odds of suicide attempt among soldiers in a unit with 5 or more past-year attempts was more than twice that of soldiers in a unit with no previous attempts (OR, 2.3; 95% CI, 2.1-2.6). The association of previous unit suicide attempts with subsequent risk was significant whether soldiers had a combat arms MOS or other MOS (ORs, 1.4-2.3; P < .001) and regardless of unit size, with the highest risk among those in smaller units (1-40 soldiers) (ORs, 2.1-5.9; P < .001). The population-attributable risk proportion for 1 or more unit suicide attempts in the past year indicated that, if this risk could be reduced to no unit attempts, 18.2% of attempts would not occur. Conclusions and Relevance: Risk of suicide attempt among soldiers increased as the number of past-year suicide attempts within their unit increased for combat arms and other MOSs and for units of any size but particularly for smaller units. Units with a history of suicide attempts may be important targets for preventive interventions.

Using actigraphy feedback to improve sleep in soldiers: an exploratory trial.

OBJECTIVES: The objective of this study was to assess the impact of wearing an actigraph and receiving personalized feedback on the sleep of a high-risk occupational group: United States soldiers recently returned from a combat deployment. DESIGN: Following a baseline survey with a full sample, a subsample of soldiers wore an actigraph, received feedback, and completed a brief survey. Two months later, the full sample completed a follow-up survey. The actigraph intervention involved wearing an actigraph for 3 weeks and then receiving a personalized report about sleep patterns and an algorithm-based estimate of cognitive functioning derived from individual sleep patterns. RESULTS: Propensity score matching with a genetic search algorithm revealed that subjects in the actigraph condition (n=43) reported fewer sleep problems (t value = -2.55, P<.01) and getting more sleep hours (t value =1.97, P<.05) at follow-up than those in a matched comparison condition (n=43, weighted). There were no significant differences in functioning, somatic symptoms, and mental health outcomes (posttraumatic stress disorder symptoms and depression). A significant interaction indicated that the actigraph had a more beneficial effect on those with more somatic symptoms at baseline but not those with more sleep problems. Most participants rated the personalized report as helpful. CONCLUSION: Actigraphs combined with personalized reports may offer a useful, simple intervention to improve the sleep patterns of large, high-risk occupational groups.

Sexual Assault Victimization and Mental Health Treatment, Suicide Attempts, and Career Outcomes Among Women in the US Army.

OBJECTIVES: To examine associations of administratively recorded sexual assault victimization during military service with subsequent mental health and negative career outcomes among US Army women controlling for nonrandom victimization exposure. METHODS: We used data from the Army Study to Assess Risk and Resilience in Servicemembers to apply propensity score methods to match all 4238 female Regular Army soldiers with administratively recorded sexual assault victimization during 2004 to 2009 to 5 controls per case with similar composite victimization risk. We examined associations of this victimization measure with administratively recorded mental health treatment, suicide attempt, and Army career outcomes over the subsequent 12 months by using survival analysis for dichotomous outcomes and conditional generalized linear models for continuous outcomes. RESULTS: Women with administratively recorded sexual assault had significantly elevated odds ratios (ORs) of subsequent mental health treatment (any, OR = 2.5; 95% confidence interval [CI] = 2.4, 2.6; specialty, OR = 3.1; 95% CI = 2.9, 3.3; inpatient, OR = 2.8; 95% CI = 2.5, 3.1), posttraumatic stress disorder treatment (any, OR = 6.3; 95% CI = 5.7, 6.9; specialty, OR = 7.7; 95% CI = 6.8, 8.6; inpatient, OR = 6.8; 95% CI = 5.4, 8.6), suicide attempt (OR = 3.0; 95% CI = 2.5, 3.6), demotion (OR = 2.1; 95% CI = 1.9, 2.3), and attrition (OR = 1.2; 95% CI = 1.1, 1.2). CONCLUSIONS: Sexual assault victimization is associated with considerable suffering and likely decreased force readiness.