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Sampson, Nancy

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Sampson, Nancy
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    Associations of Housing Mobility Interventions for Children in High-Poverty Neighborhoods With Subsequent Mental Disorders During Adolescence
    (American Medical Association (AMA), 2014) Kessler, Ronald; Duncan, Greg J.; Gennetian, Lisa A.; Katz, Lawrence; Kling, Jeffrey R.; Sampson, Nancy; Sanbonmatsu, Lisa; Zaslavsky, Alan; Ludwig, Jens
    Importance Youth in high-poverty neighborhoods have high rates of emotional problems. Understanding neighborhood influences on mental health is crucial for designing neighborhood-level interventions. Objective To perform an exploratory analysis of associations between housing mobility interventions for children in high-poverty neighborhoods and subsequent mental disorders during adolescence. Design, Setting, and Participants The Moving to Opportunity Demonstration from 1994 to 1998 randomized 4604 volunteer public housing families with 3689 children in high-poverty neighborhoods into 1 of 2 housing mobility intervention groups (a low-poverty voucher group vs a traditional voucher group) or a control group. The low-poverty voucher group (n=1430) received vouchers to move to low-poverty neighborhoods with enhanced mobility counseling. The traditional voucher group (n=1081) received geographically unrestricted vouchers. Controls (n=1178) received no intervention. Follow-up evaluation was performed 10 to 15 years later (June 2008-April 2010) with participants aged 13 to 19 years (0-8 years at randomization). Response rates were 86.9% to 92.9%. Main Outcomes and Measures Presence of mental disorders from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) within the past 12 months, including major depressive disorder, panic disorder, posttraumatic stress disorder (PTSD), oppositional-defiant disorder, intermittent explosive disorder, and conduct disorder, as assessed post hoc with a validated diagnostic interview. Results Of the 3689 adolescents randomized, 2872 were interviewed (1407 boys and 1465 girls). Compared with the control group, boys in the low-poverty voucher group had significantly increased rates of major depression (7.1% vs 3.5%; odds ratio (OR), 2.2 [95% CI, 1.2-3.9]), PTSD (6.2% vs 1.9%; OR, 3.4 [95% CI, 1.6-7.4]), and conduct disorder (6.4% vs 2.1%; OR, 3.1 [95% CI, 1.7-5.8]). Boys in the traditional voucher group had increased rates of PTSD compared with the control group (4.9% vs 1.9%, OR, 2.7 [95% CI, 1.2-5.8]). However, compared with the control group, girls in the traditional voucher group had decreased rates of major depression (6.5% vs 10.9%; OR, 0.6 [95% CI, 0.3-0.9]) and conduct disorder (0.3% vs 2.9%; OR, 0.1 [95% CI, 0.0-0.4]). Conclusions and Relevance Interventions to encourage moving out of high-poverty neighborhoods were associated with increased rates of depression, PTSD, and conduct disorder among boys and reduced rates of depression and conduct disorder among girls. Better understanding of interactions among individual, family, and neighborhood risk factors is needed to guide future public housing policy changes. Observational studies have consistently found that youth in high-poverty neighborhoods have high rates of emotional problems even after controlling for individual-level risk factors.1 These findings raise the possibilities that neighborhood characteristics affect emotional functioning2 and neighborhood-level interventions may reduce emotional problems. Available data from observational studies are unclear and subject to selection bias and the possibility of reverse causality (ie, families with emotional problems end up in poorer neighborhoods). Despite this uncertainty, presumptive neighborhood effects have been characterized,3 causal pathways have been hypothesized,4 and interventions have been implemented.5 It is important to evaluate these causal claims regarding neighborhood effects experimentally. The US Department of Housing and Urban Development (HUD) enacted a housing mobility experiment known as the Moving to Opportunity for Fair Housing Demonstration by randomizing volunteer low-income public housing families with children to receive vouchers to move to lower-poverty neighborhoods.6,7 An interim evaluation 4 to 7 years after randomization showed that the intervention caused families to move to better neighborhoods with lower poverty and crime rates and increased social ties with more affluent people.8 Significant reductions in psychological distress and depression were also found among adolescent girls in the intervention group vs the control group but increased behavior problems were found among adolescent boys in the intervention group vs the control group.9- 11 Given the importance of these sex differences, clinically significant mental disorders were included in a long-term (10-15 years after randomization) follow-up assessment. Prior long-term follow-up reports documented effects on improved neighborhood characteristics,12,13 reduced adult extreme obesity and diabetes,14 and improved adult subjective well-being.13 No detectable effects on economic self-sufficiency were found.13 Although long-term evaluation found significantly reduced psychological distress among adolescent girls,15 measures of mental disorders were not examined in previous reports. The primary objectives of the Moving to Opportunity study were to move families to lower-poverty neighborhoods and increase educational achievement and economic self-sufficiency. Mental disorders were measured as post hoc outcomes. The current report presents the first exploratory analyses evaluating long-term associations of housing mobility randomization with mental disorders among participants who were in early childhood at randomization and adolescence at follow-up.
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    Parental psychopathology and the risk of suicidal behavior in their offspring: results from the World Mental Health surveys
    (Springer Nature, 2010) Gureje, O; Oladeji, Bibilola; Hwang, Irving; Chiu, Wai; Kessler, Ronald; Sampson, Nancy; Alonso, Jose; Andrade, Luis; Beautrais, A; Borges, G; Bromet, E; Bruffaerts, R; de Girolamo, G; de Graaf, R; Gal, G; He, Y; Hu, C; Iwata, N; Karam, E G; Kovess-Masféty, V; Matschinger, H; Moldovan, M V; Posada-Villa, J; Sagar, R; Scocco, P; Seedat, S; Tomov, Toma; Nock, Matthew
    Prior research suggests that parental psychopathology predicts suicidal behavior among offspring; however, the more fine-grained associations between specific parental disorders and distinct stages of the pathway to suicide are not well-understood. We set out to test the hypothesis that parental disorders associated with negative mood would predict offspring suicide ideation, whereas disorders characterized by impulsive-aggression (e,g., antisocial personality) and anxiety/agitation (e.g., panic disorder) would predict which offspring act on their suicide ideation and make a suicide attempt. Data were collected during face-to-face interviews conducted on nationally representative samples (N=55,299; age 18+) from 21 countries around the world. We tested the associations between a range of parental disorders and the onset and persistence over time (i.e., time-since-most-recent-episode controlling for age-of-onset and time-since-onset) of subsequent suicidal behavior (suicide ideation, plans, and attempts) among offspring. Analyses tested bivariate and multivariate associations between each parental disorder and distinct forms of suicidal behavior. Results revealed that each parental disorder examined increased the risk of suicide ideation among offspring, parental generalized anxiety and depression emerged as the only predictors of the onset and persistence (respectively) of suicide plans among offspring with ideation, whereas parental anti-social personality and anxiety disorders emerged as the only predictors of the onset and persistence of suicide attempts among ideators. A dose-response relation between parental disorders and respondent risk of suicide ideation and attempt also was found. Parental death by suicide was a particularly strong predictor of persistence of suicide attempts among offspring. These associations remained significant after controlling for comorbidity of parental disorders and for the presence of mental disorders among offspring. These findings should inform future explorations of the mechanisms of inter-generational transmission of suicidal behavior.
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    Mental Disorders, Comorbidity, and Pre-enlistment Suicidal Behavior Among New Soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)
    (Wiley-Blackwell, 2015) Nock, Matthew; Ursano, Robert J.; Heeringa, Steven G.; Stein, Murray B.; Jain, Sonia; Raman, Rema; Sun, Xiaoying; Chiu, Wai; Colpe, Lisa J.; Fullerton, Carol S.; Gilman, Stephen Edward; Hwang, Irving; Naifeh, James A.; Rosellini, Anthony; Sampson, Nancy; Schoenbaum, Michael; Zaslavsky, Alan; Kessler, Ronald
    We examined the associations between mental disorders and suicidal behavior (ideation, plans, and attempts) among new soldiers using data from the New Soldier Study (NSS) component of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS; n=38,507). Most new soldiers with a pre-enlistment history of suicide attempt reported a prior mental disorder (59.0%). Each disorder examined was associated with increased odds of suicidal behavior (ORs=2.6–8.6). Only PTSD and disorders characterized by irritability and impulsive/aggressive behavior (i.e., bipolar disorder, conduct disorder, oppositional defiant disorder, and attention-deficit/hyperactivity disorder) predicted unplanned attempts among ideators. Mental disorders are important predictors of pre-enlistment suicidal behavior among new soldiers and should figure prominently in suicide screening and prevention efforts.
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    Prevalence and correlates of suicidal behavior among new soldiers in the US Army: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)
    (Wiley-Blackwell, 2014) Ursano, Robert J.; Heeringa, Steven G.; Stein, Murray B.; Jain, Sonia; Raman, Rema; Sun, Xiaoying; Chiu, Wai; Colpe, Lisa J.; Fullerton, Carol S.; Gilman, Stephen Edward; Hwang, Irving; Naifeh, James A.; Nock, Matthew; Rosellini, Anthony; Sampson, Nancy; Schoenbaum, Michael; Zaslavsky, Alan; Kessler, Ronald
    Background The prevalence of suicide among U.S. Army soldiers has risen dramatically in recent years. Prior studies suggest that most soldiers with suicidal behaviors (i.e., ideation, plans, and attempts) had first onsets prior to enlistment. However, those data are based on retrospective self-reports of soldiers later in their Army careers. Unbiased examination of this issue requires investigation of suicidality among new soldiers. Method The New Soldier Study (NSS) of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) used fully structured self-administered measures to estimate preenlistment histories of suicide ideation, plans, and attempts among new soldiers reporting for Basic Combat Training in 2011–2012. Survival models examined sociodemographic correlates of each suicidal outcome. Results Lifetime prevalence estimates of preenlistment suicide ideation, plans, and attempts were 14.1, 2.3, and 1.9%, respectively. Most reported onsets of suicide plans and attempts (73.3–81.5%) occurred within the first year after onset of ideation. Odds of these lifetime suicidal behaviors among new soldiers were positively, but weakly associated with being female, unmarried, religion other than Protestant or Catholic, and a race/ethnicity other than non-Hispanic White, non-Hispanic Black, or Hispanic. Conclusions Lifetime prevalence estimates of suicidal behaviors among new soldiers are consistent with retrospective reports of preenlistment prevalence obtained from soldiers later in their Army careers. Given that prior suicidal behaviors are among the strongest predictors of later suicides, consideration should be given to developing methods of obtaining valid reports of preenlistment suicidality from new soldiers to facilitate targeting of preventive interventions.
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    Lifetime Prevalence of Dsm-Iv Mental Disorders Among New Soldiers in the U.S. Army: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)
    (Wiley-Blackwell, 2014) Rosellini, Anthony; Heeringa, Steven G.; Stein, Murray B.; Ursano, Robert J.; Chiu, Wai; Colpe, Lisa J.; Fullerton, Carol S.; Gilman, Stephen Edward; Hwang, Irving; Naifeh, James A.; Nock, Matthew; Petukhova, Maria; Sampson, Nancy; Schoenbaum, Michael; Zaslavsky, Alan; Kessler, Ronald
    Background The prevalence of 30-day mental disorders with retrospectively-reported early onsets is significantly higher in the U.S. Army than among socio-demographically matched civilians. This difference could reflect high prevalence of pre-enlistment disorders and/or high persistence of these disorders in the context of the stresses associated with military service. These alternatives can to some extent be distinguished by estimating lifetime disorder prevalence among new Army recruits. Methods The New Soldier Study (NSS) in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) used fully-structured measures to estimate lifetime prevalence of 10 DSM-IV disorders in new soldiers reporting for Basic Combat Training in 2011-2012 (n=38,507). Prevalence was compared to estimates from a matched civilian sample. Multivariate regression models examined socio-demographic correlates of disorder prevalence and persistence among new soldiers. Results Lifetime prevalence of having at least one internalizing, externalizing, or either type of disorder did not differ significantly between new soldiers and civilians, although three specific disorders (generalized anxiety, posttraumatic stress, and conduct disorders) and multi-morbidity were significantly more common among new soldiers than civilians. Although several socio-demographic characteristics were significantly associated with disorder prevalence and persistence, these associations were uniformly weak. Conclusions New soldiers differ somewhat, but not consistently, from civilians in lifetime pre-enlistment mental disorders. This suggests that prior findings of higher prevalence of current disorders with pre-enlistment onsets among soldiers than civilians are likely due primarily to a more persistent course of early-onset disorders in the context of the special stresses experienced by Army personnel.
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    Occupational differences in US Army suicide rates
    (Cambridge University Press (CUP), 2015) Kessler, Ronald; Stein, M. B.; Bliese, P. D.; Bromet, E. J.; Chiu, Wai; Cox, K. L.; Colpe, L. J.; Fullerton, C. S.; Gilman, Stephen Edward; Gruber, Michaela; Heeringa, S. G.; Lewandowski-Romps, L.; Millikan-Bell, A.; Naifeh, J. A.; Nock, Matthew; Petukhova, Maria; Rosellini, Anthony; Sampson, Nancy; Schoenbaum, M.; Zaslavsky, Alan; Ursano, R. J.
    Background Civilian suicide rates vary by occupation in ways related to occupational stress exposure. Comparable military research finds suicide rates elevated in combat arms occupations. However, no research has evaluated variation in this pattern by deployment history, the indicator of occupation stress widely considered responsible for the recent rise in the military suicide rate. Method The joint associations of Army occupation and deployment history in predicting suicides were analysed in an administrative dataset for the 729 337 male enlisted Regular Army soldiers in the US Army between 2004 and 2009. Results There were 496 suicides over the study period (22.4/100 000 person-years). Only two occupational categories, both in combat arms, had significantly elevated suicide rates: infantrymen (37.2/100 000 person-years) and combat engineers (38.2/100 000 person-years). However, the suicide rates in these two categories were significantly lower when currently deployed (30.6/100 000 person-years) than never deployed or previously deployed (41.2–39.1/100 000 person-years), whereas the suicide rate of other soldiers was significantly higher when currently deployed and previously deployed (20.2–22.4/100 000 person-years) than never deployed (14.5/100 000 person-years), resulting in the adjusted suicide rate of infantrymen and combat engineers being most elevated when never deployed [odds ratio (OR) 2.9, 95% confidence interval (CI) 2.1–4.1], less so when previously deployed (OR 1.6, 95% CI 1.1–2.1), and not at all when currently deployed (OR 1.2, 95% CI 0.8–1.8). Adjustment for a differential ‘healthy warrior effect’ cannot explain this variation in the relative suicide rates of never-deployed infantrymen and combat engineers by deployment status. Conclusions Efforts are needed to elucidate the causal mechanisms underlying this interaction to guide preventive interventions for soldiers at high suicide risk.
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    Design of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)
    (Wiley-Blackwell, 2013) Kessler, Ronald; Colpe, Lisa J.; Fullerton, Carol S.; Gebler, Nancy; Naifeh, James A.; Nock, Matthew; Sampson, Nancy; Schoenbaum, Michael; Zaslavsky, Alan; Stein, Murray B.; Ursano, Robert J.; Heeringa, Steven G.
    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 U.S. Army suicides and increase basic knowledge about the determinants of suicidality. This report presents an overview of the designs of the six component Army STARRS studies. These include: an integrated study of historical administrative data systems (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 [SAQ] 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. DoD/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.
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    Understanding the elevated suicide risk of female soldiers during deployments
    (Cambridge University Press (CUP), 2014) Street, A. E.; Gilman, Stephen Edward; Rosellini, Anthony; Stein, M. B.; Bromet, E. J.; Cox, K. L.; Colpe, L. J.; Fullerton, C. S.; Gruber, M; Heeringa, S. G.; Lewandowski-Romps, L.; Little, R. J. A.; Naifeh, J. A.; Nock, Matthew; Sampson, Nancy; Schoenbaum, M.; Ursano, R. J.; Zaslavsky, Alan; Kessler, Ronald
    Background The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) has found that the proportional elevation in the US Army enlisted soldier suicide rate during deployment (compared with the never-deployed or previously deployed) is significantly higher among women than men, raising the possibility of gender differences in the adverse psychological effects of deployment. Method Person-month survival models based on a consolidated administrative database for active duty enlisted Regular Army soldiers in 2004–2009 (n = 975 057) were used to characterize the gender × deployment interaction predicting suicide. Four explanatory hypotheses were explored involving the proportion of females in each soldier’s occupation, the proportion of same-gender soldiers in each soldier’s unit, whether the soldier reported sexual assault victimization in the previous 12 months, and the soldier’s pre-deployment history of treated mental/behavioral disorders. Results The suicide rate of currently deployed women (14.0/100 000 person-years) was 3.1–3.5 times the rates of other (i.e. never-deployed/previously deployed) women. The suicide rate of currently deployed men (22.6/100 000 person-years) was 0.9–1.2 times the rates of other men. The adjusted (for time trends, sociodemographics, and Army career variables) female:male odds ratio comparing the suicide rates of currently deployed v. other women v. men was 2.8 (95% confidence interval 1.1–6.8), became 2.4 after excluding soldiers with Direct Combat Arms occupations, and remained elevated (in the range 1.9–2.8) after adjusting for the hypothesized explanatory variables. Conclusions These results are valuable in excluding otherwise plausible hypotheses for the elevated suicide rate of deployed women and point to the importance of expanding future research on the psychological challenges of deployment for women.
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    Clinical reappraisal of the Composite International Diagnostic Interview Screening Scales (CIDI-SC) in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)
    (Wiley-Blackwell, 2013) Kessler, Ronald; Santiago, Patcho N.; Colpe, Lisa J.; Dempsey, Catherine L.; First, Michael B.; Heeringa, Steven G.; Stein, Murray B.; Fullerton, Carol S.; Gruber, M; Naifeh, James A.; Nock, Matthew; Sampson, Nancy; Schoenbaum, Michael; Zaslavsky, Alan; Ursano, Robert J.
    A clinical reappraisal study was carried out in conjunction with the Army STARRS All-Army Study (AAS) to evaluate concordance of DSM-IV diagnoses based on the Composite International Diagnostic Interview screening scales (CIDI-SC) and PTSD Checklist (PCL) with diagnoses based on independent clinical reappraisal interviews (Structured Clinical Interview for DSM-IV [SCID]). Diagnoses included: lifetime mania/hypomania, panic disorder, and intermittent explosive disorder; 6-month adult attention-deficit/hyperactivity disorder; and 30-day major depressive episode, generalized anxiety disorder, PTSD, and substance (alcohol or drug) use disorder (abuse or dependence). The sample (n=460) was weighted for over-sampling CIDI-SC/PCL screened positives. Diagnostic thresholds were set to equalize false positives and false negatives. Good individual-level concordance was found between CIDI-SC/PCL and SCID diagnoses at these thresholds (AUC = .69–.79). AUC was considerably higher for continuous than dichotomous screening scale scores (AUC = .80–.90), arguing for substantive analyses using not only dichotomous case designations but also continuous measures of predicted probabilities of clinical diagnoses.
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    Thirty-Day Prevalence ofDSM-IVMental Disorders Among Nondeployed Soldiers in the US Army
    (American Medical Association (AMA), 2014) Kessler, Ronald; Heeringa, Steven G.; Stein, Murray B.; Colpe, Lisa J.; Fullerton, Carol S.; Hwang, Irving; Naifeh, James A.; Nock, Matthew; Petukhova, Maria; Sampson, Nancy; Schoenbaum, Michael; Zaslavsky, Alan; Ursano, Robert J.
    Importance Although high rates of current mental disorder are known to exist in the US Army, little is known about the proportions of these disorders that had onsets prior to enlistment. Objective To estimate the proportions of 30-day DSM-IV mental disorders among nondeployed US Army personnel with first onsets prior to enlistment and the extent which role impairments associated with 30-day disorders differ depending on whether the disorders had pre- vs post-enlistment onsets. Design, Setting, and Participants A representative sample of 5428 soldiers participating in the Army Study to Assess Risk and Resilience in Servicemembers completed self-administered questionnaires and consented to linkage of questionnaire responses with administrative records. Main Outcomes and Measures Thirty-day DSM-IV internalizing (major depressive, bipolar, generalized anxiety, panic, and posttraumatic stress) and externalizing (attention-deficit/hyperactivity, intermittent explosive, alcohol/drug) disorders were assessed with validated self-report scales. Age at onset was assessed retrospectively. Role impairment was assessed with a modified Sheehan Disability Scale. Results A total of 25.1% of respondents met criteria for any 30-day disorder (15.0% internalizing; 18.4% externalizing) and 11.1% for multiple disorders. A total of 76.6% of cases reported pre-enlistment age at onset of at least one 30-day disorder (49.6% internalizing; 81.7% externalizing). Also, 12.8% of respondents reported severe role impairment. Controlling for sociodemographic and Army career correlates, which were broadly consistent with other studies, 30-day disorders with pre-enlistment (χ28 = 131.8, P < .001) and post-enlistment (χ27 = 123.8, P < .001) ages at onset both significantly predicted severe role impairment, although pre-enlistment disorders were more consistent powerful predictors (7 of 8 disorders significant; odds ratios, 1.6-11.4) than post-enlistment disorders (5 of 7 disorders significant; odds ratios, 1.5-7.7). Population-attributable risk proportions of severe role impairment were 21.7% for pre-enlistment disorders, 24.3% for post-enlistment disorders, and 43.4% for all disorders. Conclusions and Relevance Interventions to limit accession or increase resilience of new soldiers with pre-enlistment mental disorders might reduce prevalence and impairments of mental disorders in the US Army.