SHOS-A Investigation of Duplicate Suicide Attempt Cases (02/12/22)
I. Discovery
SHOS-A analytic work and published results include two suicide attempt cases withquestionnaires at two different time points (i.e., each soldier has two distinct questionnaires ondifferent dates].
II. Question
Several papers have been published using the SHOS-A analytic data file that includes the two
duplicate respondents. Is there reason for concern regarding how this may have affected thepublished SHOS-A results?
III. Follow up Results
A sensitivity analysis, including rerunning models, checking weights and risk scores, andexamining correlations, was undertaken to determine whether the elimination of duplicate
records might have led to results that differ from those published. The main question of interest
focused on potential bias in the regression coefficients and/or its effect on statistical significance.
A set of final models, found among the published work, was rerun eliminating duplicate cases.
Specifically, four separate data sets were created in order to capture the different possiblecombinations of unique responses from each of the two duplicate soldiers. The results ofrerunning all models with each non-duplicate data sets showed results consistent to thosepublished with the exception of one model: the model predicting suicide attempts among suicide
ideators (adjusting for socio-demographics and mental disorders) in Table 3 of Naifeh et al.
(2021). In two out of the four data sets, the main effect of distress intolerance on attempts among
ideators changed from statistically significant (p < .05) to moderately significant (p = .05 – .10).
However, the point estimate was in the same direction and of the same magnitude as thepublished results.
•See PDF below titled ‘Replicating_Papers.pdf’In order to further understand this discrepant result, we conducted a series of additional analyses:
Additional analysis included examining weights and the sum of weights. Examining eachweighted value, across both pairs of surveys, it was observed that the weighted values wereidentical. Hence, regardless of which non-duplicate data set we used in the reanalysis, theweights would be the same. The sum of the weights, when removing duplicate records, resulted
in a total sum of weights value of 72.6, identical across each dataset. In contrast, the total sum ofweights value in the original analysis equaled 74. This means that the coverage across each nonduplicate data set accounted for 98% of the original sum of weights.
•See PDF titled ‘SHOSA_SumOfWeights_111021.pdf’

We crossed checked a set of demographic variables to ascertain whether duplicate records werein fact the same individual. Duplicates matched exactly on sex, education, race, age, maritalstatus.
•See PDF titled ‘SHOSA_Demos_111021.pdf’

We examined the covariates used in the models for possible differences. We observed
differences in the risk score used to adjust the model.
•See PDF titled ‘SHOSA_Paper3_Covariate_Examination_110321.pdf’

Finally, we ran two separate models to understand the relationship between the risk score anddistress intolerance. We first examined distress intolerance as a predictor of attempts among
ideators without controlling for the risk score. We then ran the same model controlling for therisk score. Adding the risk score changes the results in one combination of duplicates but not in
the other. If we dig a little more, we see that the correlation between distress intolerance and therisk score differs between models. Thus, a possible explanation for the significance of distressintolerance in one case but not the other is due to the difference in the correlation between
distress intolerance and the risk score – the correlation was three times stronger in the model thatlost significance.
•See PDF tilled ‘SHOSA_Obs2_Analysis_111021.pdf”

IV. Conclusion
Given the thorough examination of the duplicate responders by way of our sensitivity analysis
and because results did not differ from the original published work except with one slight
exception, we feel confident with the original SHOS-A results.

References
Naifeh, J. A., Nock, M. K., Dempsey, C. L., Georg, M. W., Aliaga, P. A., Dinh, H. M., Fullerton, C. S.,
Mash, H., Kao, T. C., Sampson, N. A., Wynn, G. H., Zaslavsky, A. M., Stein, M. B., Kessler, R.
C., & Ursano, R. J. (2021). Association of emotion reactivity and distress intolerance withsuicide attempts in U.S. Army soldiers. Suicide & Life-Threatening Behavior.
https://doi.org/10.1111/sltb.12821

Source Documentation:
1.

Replicating_Papers.
pdf

Page 22.

SHOSA_SumOfWei
ghts_111021.pdf

3.

SHOSA_Demos_111
221.pdf

4.

SHOSA_Paper3_Cov
ariate_Examination_

5.

SHOSA_Obs2_Analy
sis_111021.pdf

Page 3