title: Using self-report surveys at the beginning of service to develop multi-outcome risk models for new soldiers in the U.S. Army.
abstract: BACKGROUND
  The U.S. Army uses universal preventives interventions for several negative outcomes (e.g. suicide, violence, sexual assault) with especially high risks in the early years of service. More intensive interventions exist, but would be cost-effective only if targeted at high-risk soldiers. We report results of efforts to develop models for such targeting from self-report surveys administered at the beginning of Army service.
  
  
  METHODS
  21 832 new soldiers completed a self-administered questionnaire (SAQ) in 2011-2012 and consented to link administrative data to SAQ responses. Penalized regression models were developed for 12 administratively-recorded outcomes occurring by December 2013: suicide attempt, mental hospitalization, positive drug test, traumatic brain injury (TBI), other severe injury, several types of violence perpetration and victimization, demotion, and attrition.
  
  
  RESULTS
  The best-performing models were for TBI (AUC = 0.80), major physical violence perpetration (AUC = 0.78), sexual assault perpetration (AUC = 0.78), and suicide attempt (AUC = 0.74). Although predicted risk scores were significantly correlated across outcomes, prediction was not improved by including risk scores for other outcomes in models. Of particular note: 40.5% of suicide attempts occurred among the 10% of new soldiers with highest predicted risk, 57.2% of male sexual assault perpetrations among the 15% with highest predicted risk, and 35.5% of female sexual assault victimizations among the 10% with highest predicted risk.
  
  
  CONCLUSIONS
  Data collected at the beginning of service in self-report surveys could be used to develop risk models that define small proportions of new soldiers accounting for high proportions of negative outcomes over the first few years of service.
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Rosellini
authors.affiliation: Departments of Psychiatry and Family Medicine & Public Health,University of California San Diego,La Jolla, California,USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Stein
authors.affiliation: Department of Psychiatry,Center for the Study of Traumatic Stress, Uniformed Services University School of Medicine,Bethesda, MD,USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Benedek
authors.affiliation: Darla Moore School of Business,University of South Carolina,Columbia, South Carolina,USA.
authors.forename: P D
authors.initials: PD
authors.lastname: Bliese
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA.
authors.forename: W T
authors.initials: WT
authors.lastname: Chiu
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA.
authors.forename: I
authors.initials: I
authors.lastname: Hwang
authors.affiliation: School of Law,University of Virginia,Charlottesville, VA,USA.
authors.forename: J
authors.initials: J
authors.lastname: Monahan
authors.affiliation: Department of Psychology,Harvard University,Cambridge, Massachusetts,USA.
authors.forename: M K
authors.initials: MK
authors.lastname: Nock
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA.
authors.forename: M V
authors.initials: MV
authors.lastname: Petukhova
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA.
authors.forename: N A
authors.initials: NA
authors.lastname: Sampson
authors.affiliation: National Center for PTSD, VA Boston Healthcare System,Boston, Massachusetts,USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Street
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Zaslavsky
authors.affiliation: Department of Psychiatry,Center for the Study of Traumatic Stress, Uniformed Services University School of Medicine,Bethesda, MD,USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Ursano
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000293:Adolescent; D000328:Adult; D019548:Crime Victims / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008889:Military Personnel / Q000706:statistics & numerical data*; D015233:Models, Statistical; D000066550:Physical Abuse / Q000706:statistics & numerical data*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D057566:Self Report; D012742:Sex Offenses / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Army; disciplinary problems; mental health; military; predictive modeling; risk assessment; violence