A practical risk calculator for suicidal behavior among transitioning U.S. Army soldiers: Results from the Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study (STARRS-LS)

Jaclyn C. Kearns, Emily R. Edwards, Erin P. Finley, Joseph C. Geraci, Sarah M. Gildea, Marianne Goodman, Irving Hwang, Chris J. Kennedy, Andrew J. King, Alex Luedtke, Brian P. Marx, Maria V. Petukhova, Nancy A. Sampson, Richard W. Seim, Ian H. Stanley, Murray B. Stein, Robert J. Ursano, Ronald C. Kessler

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background Risk of suicide-related behaviors is elevated among military personnel transitioning to civilian life. An earlier report showed that high-risk U.S. Army soldiers could be identified shortly before this transition with a machine learning model that included predictors from administrative systems, self-report surveys, and geospatial data. Based on this result, a Veterans Affairs and Army initiative was launched to evaluate a suicide-prevention intervention for high-risk transitioning soldiers. To make targeting practical, though, a streamlined model and risk calculator were needed that used only a short series of self-report survey questions. Methods We revised the original model in a sample of n = 8335 observations from the Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study (STARRS-LS) who participated in one of three Army STARRS 2011-2014 baseline surveys while in service and in one or more subsequent panel surveys (LS1: 2016-2018, LS2: 2018-2019) after leaving service. We trained ensemble machine learning models with constrained numbers of item-level survey predictors in a 70% training sample. The outcome was self-reported post-transition suicide attempts (SA). The models were validated in the 30% test sample. Results Twelve-month post-transition SA prevalence was 1.0% (s.e. = 0.1). The best constrained model, with only 17 predictors, had a test sample ROC-AUC of 0.85 (s.e. = 0.03). The 10-30% of respondents with the highest predicted risk included 44.9-92.5% of 12-month SAs. Conclusions An accurate SA risk calculator based on a short self-report survey can target transitioning soldiers shortly before leaving service for intervention to prevent post-transition SA.

Original languageEnglish (US)
JournalPsychological Medicine
Volume151
Issue number7
DOIs
StatePublished - Mar 9 2023
Externally publishedYes

Keywords

  • Machine learning
  • suicide attempt
  • suicide prevention
  • veterans

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Applied Psychology

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