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 address this issue. Army STARRS is a direct response to the Army’s request that NIMH enlist the most promising scientific approaches to better understand psychological resilience, mental health, and risk for self-harm among Soldiers.

*The active-duty suicide rate dropped slightly in 2010 but rose again in 2011.

Army STARRS has 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 volunteer 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 are inviting 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 is actually 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 have attempted suicide and are admitted to a medical treatment facility. SHOS-B focuses on Soldiers who have 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.

Special Studies

• 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 will have an opportunity to participate in follow-up research when they return to the United States. The Pre/Post Deployment Study, like all Army STARRS studies, is strictly voluntary.

• The Clinical Calibration Study involves in-depth clinical interviews with a variety of Soldier volunteers. Researchers will use the interviews to calibrate the diagnostic accuracy of Army STARRS questionnaires. The Clinical Calibration Study began in March 2012.

Privacy is a top priority in every study component. Soldiers' personal information is strictly confidential and individual Soldiers are not identifiable. 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.

NIMH has assembled a group of renowned experts for Army STARR including teams from the Uniformed Services University of the Health Sciences (USUHS), the University of California, San Diego, University of Michigan, Harvard Medical School, and NIMH. Additional Army and NIMH program staff will contribute to the oversight and implementation of the study. This research team brings together international leaders in military health, health and behavior surveys, epidemiology, suicide, and genetic and neurobiological factors involved in psychological health.

The interdisciplinary team is led by:

• 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 other investigators are:

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

NIMH Scientists include:

• Lisa J. Colpe, Ph.D., M.P.H., NIMH
• Michael Schoenbaum, Ph.D., NIMH

NIMH and Army oversight and implementation leadership include:

• 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.