DEPRESSION AND ANXIETY 00:1–2 (2014) Editorial TOWARD A GREATER UNDERSTANDING OF MENTAL HEALTH ISSUES IN TODAY’S MILITARY Terence M. Keane, Ph.D. ∗ Elevations in psychiatric disorders and suicides among American military constitute a pressing public-health concern. In today’s military in America, there are in- tensive efforts to screen, assess, and intervene to im- prove mental health and maintain an optimal military workforce. Yet, during the extended deployments in Afghanistan and Iraq, increases in psychiatric disorders and suicide are apparent among active-duty military and military veterans. Clearly, a completed suicide is a com- plex, multiply determined event. Commonly, it is pre- cipitated by the presence of psychiatric and substance abuse conditions. Are these elevations in rates a func- tion of deployment stress, combat stress, pre-existing propensities, current-day stressors, or an interaction of all these factors? The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS [1] ) rep- resents a systematic attempt to provide definitive infor- mation on rates of psychiatric conditions and suicide in active-duty soldiers by using epidemiological, clinical, and neurobiological methods to triangulate factors that affect onset, course, and initiation of these major mental health concerns. The goal of this great effort is for in- formation derived from Army STARRS to generate best practices and guidelines for screening, intervention, and prevention. This issue of Depression & Anxiety (D&A) presents im- portant new information from the remarkable scientific team assembled to study mental health and suicide in the U.S. Army. Using epidemiological methods to more fully understand risk and resilience factors, these articles present new, important, and nuanced information. Against the backdrop of a suite of articles in JAMA Psychiatry this past spring, these D&A articles provide information stemming from the New Soldier Study (NSS) rather than the All Army Survey (AAS) reported earlier. The NSS began its data collection at the point of Department of Veterans Affairs National Center for Posttrau- matic Stress Disorder, VA Boston Healthcare System, Boston University School of Medicine, Boston, Massachusetts ∗ Correspondence to: Terence M. Keane, National Center for Post- traumatic Stress Disorder, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. E-mail: terry.keane@va.gov DOI 10.1002/da.22324 Published online in Wiley Online Library (wileyonlinelibrary.com). soldiers’ Basic Combat Training, a group that was not included in the AAS. The reports by Ursano et al. [2] and Rosellini et al. [3] benefit by (i) the large sample of 38,507 participants that seem representative of Army recruits, (ii) the use of strong measures of the constructs under study, and (iii) the administration of measures prior to training that minimizes the confounds of reporting biases that might be a function of military training itself while also limiting the window of retrospective report- ing of onset and course of mental health conditions and self-injury variables. As it turns out, the implementation of NSS was a critical strategy in trying to understand more fully the findings from AAS. AAS found higher rates of psychiatric disorders, sui- cide ideation, suicide plans, and suicide attempts among its participants. [4] It also found that a high proportion of the psychiatric conditions measured had their onset prior to enlistment in the military. Importantly, the NSS found higher rates of only generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and con- duct disorder (CD), but it did not find differences in rates of early-onset psychiatric conditions. The absolute rates of psychological problems in the index Army group (NSS) and the comparison group were high, but not dif- ferent from one another. Policy implications change as a function of the NSS study, although Rosellini et al. [3] and Ursano et al. [2] appropriately still argue for clinical inter- ventions to assist recruits in the management of the stres- sors and rigorous life of active-duty military. Further, issues of screening do become more focused. For exam- ple, trying to screen and procure valid reporting from recruits regarding suicidal ideation, plans, and attempts becomes a focal point for policy. This problem is not easy to solve though, because admission of these experiences can preclude one from acceptance into the Army. And the Army is one key way that individuals can better their lives in terms of education, employment, and fulfillment more broadly. The key question still unresolved is why findings from the recruits differed from the all Army par- ticipants. Is it a cohort effect influenced by the decade of war? Are different people joining the military? Or is it simply a function of how the assessment methods worked with these different groups? The investigators intelli- gently consider many of these variables in their trenchant discussion, but a precise conclusion is not reached. We await the treasure trove of more information from Army STARRS and in particular this reader is very inter- ested in the developmental consequences of childhood poverty, abuse (physical and sexual), and neglect on the C  2014 Wiley Periodicals, Inc.