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The Making of Army STARRS: An Overview

The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is an unprecedented research study dealing with a topic critical to the Army and the country—suicide prevention.  It is also one of the largest, most complex studies ever administered by NIMH.

Army STARRS was launched in July 2009 to address the Army’s concern about the rising suicide rate among soldiers. In the past, the suicide rate for Army personnel has been lower than that for the civilian population. Since 2002, however, the suicide rate among soldiers has risen, reaching record levels in 2007 and again in 2008 and 2009, before falling slightly in 2010. These numbers prompted the Army to partner with NIMH to address the issue. The collaboration also includes investigators from the Uniformed Services University of the Health Sciences, Harvard Medical School, University of Michigan, and University of California, San Diego. The team will spend five years working to find factors that protect a soldier’s well-being and factors that put a soldier’s mental health at risk. Because promoting mental health and reducing suicide risk are important for all Americans, the findings from Army STARRS will benefit not only servicemembers but the nation as a whole.

In an effort to find risk and protective factors that affect soldiers’ well-being, the Army STARRS team is undertaking some enormous tasks.  For example, they have created a secure database with more than one billion Army data records and 3,000 types of information.  The team is analyzing this historical data while using surveys to gather new information.  Researchers are collecting data from soldiers in the United States, Afghanistan, and installations around the globe. All of this has been done, and will continue to be done, with extreme care for the security and confidentiality of each soldier who volunteers to participate.

Challenges

Every research study faces challenges and opportunities to develop new methods.  This is also true with Army STARRS.  The Making of Army STARRS series highlights some of the challenges and opportunities that have been part of this project.

Coordinating Cultures

The academic and military worlds may speak different languages and approach a situation from different perspectives. But when the goal is the same, everything comes together.  The Army STARRS research team has broadened its understanding of military life and acronyms just as the Army’s team has added to its knowledge of statistical sampling methods and research language. The commitment to making Army STARRS a success is what keeps everyone moving forward.

Studying a Rare Event

Suicide is a very rare and complicated event. In fact, on average, fewer than 20 people out of every 100,000 commit suicide. In addition, there are few, if any, things that are common to all suicides. For example, although some risk factors such as clinical depression or failed relationships often precede suicide, most soldiers who experience these things never try to take their own lives. Because suicide is so rare, researchers must look at very large groups of people to draw valid scientific conclusions.  Army STARRS will allow such a study because it will include a very large group of Army soldiers.

Confidentiality

Confidentiality is extremely important to every part of this project. In every component and every phase, information that could identify an individual soldier is removed from survey responses, administrative data, historical data, and biological specimens. Survey ID numbers or scrambled identifiers are attached to different types of data instead of names, addresses or Social Security numbers.

Connecting the Dots

Investigators are collecting data directly from thousands of soldiers. The team will use a special computer program to link soldiers’ Army STARRS data to data from Army and U.S. Department of Defense (DoD) administrative sources. This will be done with soldiers’ permission and in compliance with all legal and privacy protections. The special program makes it possible to link survey and administrative records in such a way that the participating soldiers cannot be personally identified in the research data. Because of this linked data, Army STARRS will support more detailed studies of both risk and protective factors for suicide than has been possible in the past.

The Big Picture

 To get a complete picture of soldiers and their experiences, Army STARRS has four primary components. The components look at both historical and current data, and each has its own chapter in The Making of Army STARRS. Findings from each of the four components may help researchers and the Army develop ways to improve soldier well-being and reduce the risk of self-harm.

The four primary components are:

  • Historical Data Study: Using data from 38 data sources from the Army and DoD, this component examines more than one billion historical health and administrative records. These records have been stripped of information that might identify an individual soldier. Investigators will use the data to focus on periods in a military career that may be high-risk, such as during deployment to a war zone, and the periods immediately before and after that deployment.
  • All Army Study (AAS): This component of Army STARRS assesses data from thousands of active duty soldier volunteers (including Reserve Component and National Guard soldiers). The AAS is looking at 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 will use this information to determine how these various factors affect soldiers’ psychological resilience, mental health, and risk for self-harm (e.g., suicide).
  • New Soldier Study (NSS): Army STARRS researchers are inviting new soldiers at the start of their basic training program to participate voluntarily in the New Soldier Study. The information gathered will look at the new soldiers’ health, personal characteristics, and prior experiences as they begin their Army service.
  • Soldier Health Outcomes Study: This part of Army STARRS is a case-control study where investigators will compare “cases” and “controls.” Soldiers who died by suicide or who are hospitalized in Army medical facilities because they attempted suicide are considered “cases.” Soldiers who had similar characteristics or experiences but did not attempt suicide are “controls.” Controls will be selected from soldiers who volunteered for the All Army Study. Researchers compare cases and controls to see how they may differ in important ways.

Monitoring Events

Headlines capture news stories that affect citizens and soldiers alike. Do these events impact soldiers’ well-being? Are changes in data trends due to local or national happenings or related to an Army intervention?  To know for sure, the research team constantly tracks major news stories, policy changes, and Army programs. They will be able to compare data and events to see if there is a relationship.