Cognitive Anxiety Sensitivity

Invariance, Longitudinal Course, and Associations With Suicide Risk in a Large Military Sample

Robison, Morgan
Patel, Tapan A.
Rice, Tyler B.
Ross, Charles P.
Velimirovic, Mina
Joiner, Thomas E.

Department of Psychology, Florida State University
23rd Medical Group, United States Air Force, Moody Air Force Base, Valdosta, Georgia, United States
Faculty of Philosophy, University of Novi Sad

Kevin D. Wu served as action editor.

This publication is based on public use data from the Military Suicide Research Consortium (MSRC). These data are available from the Veteran Association’s Suicide Prevention Research Impact NeTwork (SPRINT). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the views of the SPRINT or MSRC. The authors have no conflicts of interest to declare.

This article was funded by the National Institute of Mental Health and Neurosciences, National Institutes of Health (Grant 5T32MH093311-12), awarded to Morgan Robison. This article was funded by the U.S. Department of Defense (Grants W81XWH-10-2-0181 and W81XWH-16-2-0003) awarded to Thomas E. Joiner. The authors gratefully acknowledge the following principal investigators for providing the data used in this article: Beeta Homaifar and Melissa Amick, Michael Anestis, Lisa Brenner, Julie Cerel, Jesse Cougle, Courtney Bagge and Ken Conner, Sean Barnes, Rebecca Bernert, Nigel Bush, Bridget Matarazzo, James McNulty and Michael Olson, Norman Schmidt, Katherine Comtois, Collin Davidson, Peter Gutierrez and Thomas Joiner, Lori Johnson, Matthew Nock, Jessica Ribeiro, Deborah Yurgelun-Todd, and Gina Signoracci. Their studies have significantly contributed to the research presented here.

Morgan Robison played a lead role in conceptualization, formal analysis, investigation, and visualization and a supporting role in funding acquisition, writing–original draft, and writing–review and editing. Tapan A. Patel played a supporting role in formal analysis, visualization, writing–original draft, and writing–review and editing. Tyler B. Rice played a supporting role in writing–original draft and writing–review and editing. Charles P. Ross played a supporting role in writing–original draft and writing–review and editing. Mina Velimirovic played a supporting role in writing–original draft and writing–review and editing. Thomas E. Joiner played a lead role in data curation, methodology, and supervision and a supporting role in conceptualization, funding acquisition, writing–original draft, and writing–review and editing.

Morgan Robison, Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, United States [email protected]

Received September 20, 2024

revised May 16, 2025

Accepted May 20, 2025

Psychological Assessment Publish Ahead of Print, July 10, 2025. | DOI: 10.1037/pas0001406

This study examined cognitive anxiety sensitivity’s invariance, longitudinal course, and associations with suicidal thoughts and attempts within a large military sample (N = 1,147). First, multiple group confirmatory factor analyses assessed the latent structure of cognitive subscale from the anxiety sensitivity index (ASI-C) by group (i.e., Active Military/Veterans and men/women). Second, free-loading latent growth curve modeling assessed the stability of cognitive anxiety sensitivity across each group over four time points. Third, multiple linear regressions tested if cognitive anxiety sensitivity at the previous time point predicted suicidal thoughts and number of attempts at the following study visit, above and beyond previous suicidal thoughts, generalized anxiety, and thwarted belongingness and beyond previous lifetime attempts, respectively. The ASI-C displayed a very well-fitting unifactorial structure and metric invariance across all groups. Overall, cognitive anxiety sensitivity appeared to significantly decrease over time across all groups, significantly more so for Active Military personnel than for Veterans and significantly more so for women than for men. Cognitive anxiety sensitivity predicted future suicidal thoughts at Time Point (T) 4 above and beyond control variables among Active Military and T2 and T3 among men but not for Veterans or women. Further, cognitive anxiety sensitivity predicted future suicide attempts at T3 beyond control variables among Active Military, Veterans, and men but was not for women. Findings suggest that cognitive anxiety sensitivity is worth including in suicide risk screening and, due to its malleability, may be a viable treatment target to reduce suicide risk among Active Military and Veteran men.