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Self-report battery may improve risk assessment in soldiers with suicidal ideation

A cross-validated model that included self-reported history and severity of suicidality, positive screens for mental disorders and Army career characteristics was associated with suicide attempts 18 to 45 months later among soldiers with suicide ideation, according to recent findings.

Using this model, researchers found that 10% of soldiers with suicidal ideation who had the highest predicted risk accounted for 39.2% of later suicide attempts.

“The [Department of Veterans Affairs] recently began implementing a new Suicide Risk Identification Strategy that includes an annual 3-stage suicide risk screening process for all VA health care patients,” Kelly L. Zuromski, PhD, from the department of psychology, Harvard Medical School, and colleagues wrote in JAMA Network Open. “This could lead to a substantial increase in the number of patients who are required to receive an in-depth suicide risk assessment.”

Data from a recent Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) study showed that the 10% of soldiers with the highest suicide attempt risk, based on a composite risk index that included self-report survey risk factors, accounted for more than 80% of all suicide attempts among respondents with suicidal ideation. However, the study’s’ retrospective design limits its validity, according to researchers.

In this prospective proof-of-concept study, researchers examined whether this brief structured question battery can help improve suicide risk assessments by identifying U.S. Army soldiers with self-reported lifetime suicidal ideation who are at highest risk for later nonfatal suicide attempt. To evaluate administratively-reported nonfatal suicide attempt, the investigators followed 3,649 soldiers — from baseline to 18-45 months — who completed surveys in Army STARRS and reported lifetime suicidal ideation.

In total, 65 survey respondents had nonfatal suicide attempts during the study period. Zuromski and colleagues found that 26.1% of later suicide attempts occurred among 14.3% of soldiers who reported lifetime history of suicidal ideation.

Further analysis revealed that risk factors linked to suicide attempts among soldiers with previous suicidal ideation included:

• suicidal ideation recency (OR = 7.2; 95% CI, 2.9-18) and persistence (OR = 2.6; 95% CI, 1-6.8);
• positive screens for mental disorders (OR = 26.2; 95% CI, 6.1-112); and
• Army career characteristics, specifically junior enlisted rank (OR = 30; 95% CI, 3.3-272.5) and senior enlisted rank (OR = 6.7; 95% CI, 0.8-54.9).
• The area under the curve of the cross-validated model for assessing risk for suicide attempt was 0.78.

“In making successive refinements to create an optimal index, it would be useful to consider other self-report measures, emerging biomarkers, other novel measures (eg, natural language analysis of electronic clinical notes or social media posts), and shorter time horizons for [suicide attempt] risk,” Zuromski and colleagues concluded. – by Savannah Demko

Disclosure: Zuromski reports grants from the Military Suicide Research Consortium. Please see the study for all other authors’ relevant financial disclosures.