Mental Disorders, Comorbidity, and Suicidal Behavior: Results from the National Comorbidity Survey Replication

Mental disorders are among the strongest predictors of suicide attempts. However, little is known about which disorders are uniquely associated with suicidal behavior due to high levels of psychiatric comorbidity. We examined the unique associations between individual disorders and subsequent suicidal behavior (suicide ideation, plans, and attempts) using data from the National Comorbidity Survey Replication, a nationally representative household survey of 9,282 US adults. Results revealed that approximately 80% of suicide attempters in the US have a temporally prior mental disorder. Anxiety, mood, impulse-control, and substance disorders all significantly predict subsequent suicide attempts in bivariate analyses (odds ratios=2.7-6.7); however, these associations decrease substantially in multivariate analyses controlling for comorbidity (odds ratios=1.5-2.3) but remain statistically significant in most cases. Disaggregation of the observed effects reveals that depression predicts suicide ideation, but not suicide plans or attempts among those with ideation. Instead, disorders characterized by severe anxiety/agitation (e.g., PTSD) and poor impulse-control (e.g., conduct disorder, substance disorders) predict which suicide ideators go on to make a plan or attempt. These results advance understanding of the unique associations between mental disorders and different forms of suicidal behavior. Future research must further delineate the mechanisms through which people come to think about suicide and progress from suicidal thoughts to attempts.Psycholog

Recovery from PTSD following Hurricane Katrina

Background: We examined patterns and correlates of speed of recovery of estimated posttraumatic stress disorder (PTSD) among people who developed PTSD in the wake of Hurricane Katrina. Method: A probability sample of prehurricane residents of areas affected by Hurricane Katrina was administered a telephone survey 7–19 months following the hurricane and again 24–27 months posthurricane. The baseline survey assessed PTSD using a validated screening scale and assessed a number of hypothesized predictors of PTSD recovery that included sociodemographics, prehurricane history of psychopathology, hurricane‐related stressors, social support, and social competence. Exposure to posthurricane stressors and course of estimated PTSD were assessed in a follow‐up interview. Results: An estimated 17.1% of respondents had a history of estimated hurricane‐related PTSD at baseline and 29.2% by the follow‐up survey. Of the respondents who developed estimated hurricane‐related PTSD, 39.0% recovered by the time of the follow‐up survey with a mean duration of 16.5 months. Predictors of slow recovery included exposure to a life‐threatening situation, hurricane‐related housing adversity, and high income. Other sociodemographics, history of psychopathology, social support, social competence, and posthurricane stressors were unrelated to recovery from estimated PTSD. Conclusions: The majority of adults who developed estimated PTSD after Hurricane Katrina did not recover within 18–27 months. Delayed onset was common. Findings document the importance of initial trauma exposure severity in predicting course of illness and suggest that pre‐ and posttrauma factors typically associated with course of estimated PTSD did not influence recovery following Hurricane Katrina. Depression and Anxiety, 2011.  © 2011 Wiley‐Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87167/1/20790_ftp.pd

Design of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multi‐component epidemiological and neurobiological study designed to generate actionable evidence‐based recommendations to reduce US Army suicides and increase basic knowledge about the determinants of suicidality. This report presents an overview of the designs of the six components of the Army STARRS. These include: an integrated analysis of the Historical Administrative Data Study (HADS) designed to provide data on significant administrative predictors of suicides among the more than 1.6 million soldiers on active duty in 2004–2009; retrospective case‐control studies of suicide attempts and fatalities; separate large‐scale cross‐sectional studies of new soldiers (i.e. those just beginning Basic Combat Training [BCT], who completed self‐administered questionnaires [SAQs] and neurocognitive tests and provided blood samples) and soldiers exclusive of those in BCT (who completed SAQs); a pre‐post deployment study of soldiers in three Brigade Combat Teams about to deploy to Afghanistan (who completed SAQs and provided blood samples) followed multiple times after returning from deployment; and a platform for following up Army STARRS participants who have returned to civilian life. Department of Defense/Army administrative data records are linked with SAQ data to examine prospective associations between self‐reports and subsequent suicidality. The presentation closes with a discussion of the methodological advantages of cross‐component coordination. Copyright © 2013 John Wiley & Sons, Ltd .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102177/1/mpr1401.pd

Field procedures in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multi‐component epidemiological and neurobiological study of unprecedented size and complexity designed to generate actionable evidence‐based recommendations to reduce US Army suicides and increase basic knowledge about determinants of suicidality by carrying out coordinated component studies. A number of major logistical challenges were faced in implementing these studies. The current report presents an overview of the approaches taken to meet these challenges, with a special focus on the field procedures used to implement the component studies. As detailed in the paper, these challenges were addressed at the onset of the initiative by establishing an Executive Committee, a Data Coordination Center (the Survey Research Center [SRC] at the University of Michigan), and study‐specific design and analysis teams that worked with staff on instrumentation and field procedures. SRC staff, in turn, worked with the Office of the Deputy Under Secretary of the Army (ODUSA) and local Army Points of Contact (POCs) to address logistical issues and facilitate data collection. These structures, coupled with careful fieldworker training, supervision, and piloting, contributed to the major Army STARRS data collection efforts having higher response rates than previous large‐scale studies of comparable military samples. Copyright © 2013 John Wiley & Sons, Ltd .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102238/1/mpr1400.pd

Response bias, weighting adjustments, and design effects in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multi‐component epidemiological and neurobiological study designed to generate actionable recommendations to reduce US Army suicides and increase knowledge about determinants of suicidality. Three Army STARRS component studies are large‐scale surveys: one of new soldiers prior to beginning Basic Combat Training (BCT; n  = 50,765 completed self‐administered questionnaires); another of other soldiers exclusive of those in BCT ( n  = 35,372); and a third of three Brigade Combat Teams about to deploy to Afghanistan who are being followed multiple times after returning from deployment ( n  = 9421). Although the response rates in these surveys are quite good (72.0–90.8%), questions can be raised about sample biases in estimating prevalence of mental disorders and suicidality, the main outcomes of the surveys based on evidence that people in the general population with mental disorders are under‐represented in community surveys. This paper presents the results of analyses designed to determine whether such bias exists in the Army STARRS surveys and, if so, to develop weights to correct for these biases. Data are also presented on sample inefficiencies introduced by weighting and sample clustering and on analyses of the trade‐off between bias and efficiency in weight trimming. Copyright © 2013 John Wiley & Sons, Ltd .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102203/1/mpr1399.pd

The Co-Production of Sustainable Future Scenarios

Scenarios are a tool to develop plausible, coherent visions about the future and to foster anticipatory knowledge. We present the Sustainable Future Scenarios (SFS) framework and demonstrate its application through the Central Arizona-Phoenix Long-term Ecological Research (CAP LTER) urban site. The SFS approach emphasizes the co-development of positive and long-term alternative future visions. Through a collaboration of practitioner and academic stakeholders, this research integrates participatory scenario development, modeling, and qualitative scenario assessments. The SFS engagement process creates space to question the limits of what is normally considered possible, desirable, or inevitable in the face of future challenges. Comparative analyses among the future scenarios demonstrate trade-offs among regional and microscale temperature, water use, land-use change, and co-developed resilience and sustainability indices. SFS incorporate diverse perspectives in co-producing positive future visions, thereby expanding traditional future projections. The iterative, interactive process also creates opportunities to bridge science and policy by building anticipatory and systems-based decision-making and research capacity for long-term sustainability planning

Predictive validity and correlates of selfâ assessed resilience among U.S. Army soldiers

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142339/1/da22694.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142339/2/da22694_am.pd

Trends in mental illness and suicidality after Hurricane Katrina

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/58324/1/kessler_trends in mental illness_2008.pd

Approximating A Dsm‐5 Diagnosis Of Ptsd Using Dsm‐Iv Criteria

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111929/1/da22364.pd

The importance of physical and mental health in explaining health-related academic role impairment among college students

Research consistently documents high rates of mental health problems among college students and strong associations of these problems with academic role impairment. Less is known, though, about prevalence and effects of physical health problems in relation to mental health problems. The current report investigates this by examining associations of summary physical and mental health scores from the widely-used Short-Form 12 (SF-12) Health Survey with self-reported academic role functioning in a self-report survey of 3,855 first-year students from five universities in the northeastern United States (US; mean age 18.5; 53.0% female). The mean SF-12 physical component summary (PCS) score (55.1) was half a standard deviation above the benchmark US adult population mean. The mean SF-12 mental component summary (MCS) score (38.2) was more than a full standard deviation below the US adult population mean. Two-thirds of students (67.1%) reported at least mild and 10.5% severe health-related academic role impairment on a modified version of the Sheehan Disability Scale. Both PCS and MCS scores were significantly and inversely related to these impairment scores, but with nonlinearities and interactions and much stronger associations involving MCS than PCS. Simulation suggests that an intervention that improved the mental health of all students with scores below the MCS median to be at the median would result in a 61.3% reduction in the proportion of students who experienced severe health-related academic role impairment. Although low-cost scalable interventions exist to address student mental health problems, pragmatic trials are needed to evaluate the effectiveness of these interventions in reducing academic role impairment