title: Insomnia brings soldiers into mental health treatment, predicts treatment engagement, and outperforms other suicide-related symptoms as a predictor of major depressive episodes.
abstract: Given the high rates of suicide among military personnel and the need to characterize suicide risk factors associated with mental health service use, this study aimed to identify suicide-relevant factors that predict: (1) treatment engagement and treatment adherence, and (2) suicide attempts, suicidal ideation, and major depressive episodes in a military sample. Army recruiters (N = 2596) completed a battery of self-report measures upon study enrollment. Eighteen months later, information regarding suicide attempts, suicidal ideation, major depressive episodes, and mental health visits were obtained from participants' military medical records. Suicide attempts and suicidal ideation were very rare in this sample; negative binomial regression analyses with robust estimation were used to assess correlates and predictors of mental health treatment visits and major depressive episodes. More severe insomnia and agitation were significantly associated with mental health visits at baseline and over the 18-month study period. In contrast, suicide-specific hopelessness was significantly associated with fewer mental health visits. Insomnia severity was the only significant predictor of major depressive episodes. Findings suggest that assessment of sleep problems might be useful in identifying at-risk military service members who may engage in mental health treatment. Additional research is warranted to examine the predictive validity of these suicide-related symptom measures in a more representative, higher suicide risk military sample.
authors.affiliation: Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee FL 32306, United States. Electronic address: hom@psy.fsu.edu.
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Hom
authors.affiliation: Office of the Army Surgeon General, 7700 Arlington Boulevard, Falls Church, VA 22041, United States.
authors.forename: Ingrid C
authors.initials: IC
authors.lastname: Lim
authors.affiliation: Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee FL 32306, United States.
authors.forename: Ian H
authors.initials: IH
authors.lastname: Stanley
authors.affiliation: Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee FL 32306, United States.
authors.forename: Bruno
authors.initials: B
authors.lastname: Chiurliza
authors.affiliation: Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee FL 32306, United States.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Podlogar
authors.affiliation: Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee FL 32306, United States.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Michaels
authors.affiliation: Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee FL 32306, United States.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Buchman-Schmitt
authors.affiliation: Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee FL 32306, United States.
authors.forename: Caroline
authors.initials: C
authors.lastname: Silva
authors.affiliation: Department of Psychological Sciences, Vanderbilt University, 111 21st Avenue South, Nashville, TN 37240, United States.
authors.forename: Jessica D
authors.initials: JD
authors.lastname: Ribeiro
authors.affiliation: Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee FL 32306, United States.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Joiner
mesh_terms: D000293:Adolescent; D000328:Adult; D003865:Major Depressive Disorder / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D010349:Patient Compliance; D010358:Patient Participation; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011595:Psychomotor Agitation; D057566:Self Report; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D059020:Suicidal Ideation; D013406:Suicide, Attempted; D055815:Young Adult
keywords: Agitation; Depression; Sleep; Suicide; Treatment engagement