Army STARRS Studies
Army STARRS was not a single study. The research team designed Army STARRS as a multi-study project consisting of eight separate but integrated epidemiologic and neurobiologic studies. This unique design allowed the researchers to use a creative and comprehensive approach to investigate risk factors and protective factors for suicide, suicide-related behaviors, and related mental and behavioral health issues.
The design included large and representative samples of Soldiers, historical and prospective data, comprehensive and calibrated measures, confidential assessments, neurocognitive tests and biomarkers. This broad and state-of-the-art approach to meet the research objectives was designed to provide practical and actionable information to the Army.
In addition, Army STARRS participants were asked for consent to link their Army and DoD administrative data to their self-reported questionnaire data, and to be re-contacted for to-be-determined future follow-up studies. The Army STARRS data are enriched by being linked with a vast assortment of administrative records, biospecimens, genomic data, and other biological assay data derived from biospecimens. Links to prospective administrative data are of special importance because they facilitate a wide range of investigations otherwise impossible in cross-sectional studies.
- Historical Administrative Data Study (HADS)
- New Soldier Study (NSS)
- All Army Study (AAS)
- Soldier Health Outcomes Study A (SHOS-A)
- Soldier Health Outcomes Study B (SHOS-B)
- Pre/Post Deployment Study (PPDS)
- Criminal Investigation Division Study (CID)
- Clinical Reappraisal Study (CRS)
HADS was designed to assess the Army of 2004-2009. The research team obtained, compiled, organized, merged, integrated, and analyzed existing Army and DoD administrative data from 37 different sources. HADS includes more than 1.1 billion de-identified Army and DoD records for more than 1.6 million active duty Soldiers (including Guard and Reserve) from 2004 to 2009. HADS involved an enormous administrative effort to get access to these data, and a massive data management effort to process and document this huge volume of data. The enormous HADS database allows analyses never before possible.
NSS was designed to assess health, personal characteristics, and prior experiences of new Soldiers as they entered Army service. The research team administered questionnaires and a battery of neurocognitive tests to Soldiers at 3 sites: Ft. Jackson, Ft. Benning and Ft. Leonard Wood from February 2011 to November 2012, and collected blood samples from Soldiers from September 2011 to November 2012. 55,814 Soldiers participated in the questionnaire administration group sessions and 34,986 provided a blood sample which was ~80% of those who were asked to provide blood.
AAS was designed to assess Soldiers (including Guard and Reserve) across all phases of Army service. The research team administered questionnaires in group sessions at more than 50 different sites within the continental US (CONUS) and outside the continental US (OCONUS). 32,272 Soldiers participated in the questionnaire administration from January 2011 through April 2013.
To include Soldiers in the AAS who were deployed to Afghanistan, the research team designed an “in-theater” AAS sub-study. This sub-study involved administering questionnaires to Soldiers in Kuwait as they transited out of Afghanistan for R&R or back into Afghanistan after R&R. 8,938 Soldiers participated in the AAS in-theater sub-study questionnaire administration from March through September 2012.
SHOS-A was a case-control study designed to assess Soldiers who were hospitalized for a suicide attempt (cases) and compare them to control Soldiers from the AAS. The research team administered questionnaires, performed neurocognitive tests, and collected blood at 5 Military Treatment Facilities (JBLM, Walter Reed, Ft. Hood, Ft. Bragg and Ft. Stewart) from November 2011 through December 2013. 561 Soldiers were enrolled in SHOS-A (186 cases and 375 controls), and 296 Soldiers provided a blood sample.
SHOS-B was a case-control study designed to assess Soldiers who committed suicide (cases) and compare them to control Soldiers from the AAS. The research team interviewed Army supervisors and next-of-kin of the cases and the controls from March 2012 through January 2014. 150 cases and 276 controls were enrolled in SHOS-B and 603 interviews were completed with Army supervisors and next of kin. SHOS-B is by far the largest psychological autopsy study of a military population, and one of the largest suicide psychological autopsy studies ever done.
The PPDS was a longitudinal study designed to follow deploying Soldiers over time to assess the effects of deployment. PPDS involved 3 Brigade Combat Teams (BCTs) at JBLM, Ft. Bragg and Ft. Carson. PPDS included questionnaire administration at 4 different time-points (1 pre-deployment and 3 post-deployment) and blood collection at 2 different time-points (1 pre-deployment and 1 post-deployment) from January 2012 through April 2014.
The 4 data collection time-points and number of Soldiers who participated in each were:
- Pre-deployment Time 0 (T0) at ~2-3 weeks before deployment. (9,488 Soldiers participated in the questionnaire and 8,090 participated in the blood collection).
- Post-deployment Time 1 (T1) at ~2-3 weeks following redeployment. (10,116 Soldiers participated in the questionnaire and 8,822 participated in the blood collection).
- Post-deployment Time 2 (T2) at ~2-3 months following redeployment. (9,193 Soldiers participated in the questionnaire).
- Post-deployment Time 3 (T3) at ~8-9 months following redeployment. (6,977 Soldiers participated in the questionnaire).
The CID Study was conducted from 2011 to 2013 and involved a systematic review and abstraction of data from Army CID file reports for all 1,311 deaths of an Army Service member from 2005 to 2009 due to suicide, accident, traffic fatality, justifiable homicide, or undetermined cause. The CID study was designed to capture relevant data about circumstances and events surrounding these deaths. The research team performed thematic coding and qualitative analysis of the CID reports. The team also used the information collected to assess the potential for misclassification of suicide cases by medical examiners.
The CRS was designed to be used by the research team to validate and calibrate the mental disorder diagnostic screening tools used in the Army STARRS questionnaires. Trained mental health professionals administered “gold standard” diagnostic clinical interviews from March through November 2012 to 460 Soldiers who had previously completed the AAS questionnaire.