Longitudinal courses of suicidal ideation in US military veterans: a 7-year population-based, prospective cohort study
Longitudinal courses of suicidal ideation in US military veterans: a 7-year population-based, prospective cohort study
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DOI：
10.1017/s0033291721000301
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发表时间：
2021-02-19
影响因子：
6.9
通讯作者：
Pietrzak, Robert H.
中科院分区：
文献类型：
--
作者：
Herzog, Sarah;Tsai, Jack;Pietrzak, Robert H.
自杀意念（SI）的不同纵向过程可能与独特的风险和保护因素有关。方法：对2291名美国退伍军人的国家概率样本进行了为期7年的四次评估，以研究广泛的基线风险和保护因素如何预测SI的不同病程。结果大多数退伍军人（82.6%）在基线和所有随访时否认SI，而8.7%有新发SI，5.4%为慢性SI，3.3%为缓解SI。与无SI组相比，慢性SI与儿童期创伤、基线重度抑郁和/或创伤后应激障碍（MDD/PTSD）、身体健康困难和近期创伤应激源相关。与无SI组[相对风险比（RRR）= 3.31]和慢性SI组（RRR = 4.65）相比，退伍军人有最高的既往自杀企图（SA）风险; MDD/PTSD的发生率较高（RRR = 7.62）。新发SI与最近的压力源和身体健康困难有关。所有有症状的SI组都报告了保护因素的减少，特别是社会联系，特质好奇心/探索和生活目的。结论近五分之一的退伍军人报告SI超过7年的时间，其中大多数人证明新的发病或缓解SI课程。慢性和缓解的SI可能代表特别高风险的SI课程;前者与较高的前瞻性SA率，精神和身体痛苦，后者与先前SA的可能性增加，并从社会和心理健康支持隔离。身体残疾，抑郁症/创伤后应激障碍，和最近的压力可能是重要的沉淀或维持SI的因素，而社会联系可能是自杀预防工作的一个关键目标。
Background Varied longitudinal courses of suicidal ideation (SI) may be linked to unique sets of risk and protective factors. Method A national probability sample of 2291 U.S. veterans was followed over four assessments spanning 7 years to examine how a broad range of baseline risk and protective factors predict varying courses of SI. Results Most veterans (82.6%) denied SI at baseline and all follow-ups, while 8.7% had new onset SI, 5.4% chronic SI, and 3.3% remitted SI. Compared to the no-SI group, chronic SI was associated with childhood trauma, baseline major depressive and/or posttraumatic stress disorder (MDD/PTSD), physical health difficulties, and recent traumatic stressors. Remitted veterans had the highest risk of a prior suicide attempt (SA) compared to no-SI [relative risk ratio (RRR) = 3.31] and chronic SI groups (RRR = 4.65); and high rates of MDD/PTSD (RRR = 7.62). New onset SI was associated with recent stressors and physical health difficulties. All symptomatic SI groups reported decrements in protective factors, specifically, social connectedness, trait curiosity/exploration, and purpose in life. Conclusion Nearly one-in-five veterans reported SI over a 7-year period, most of whom evidenced new onset or remitted SI courses. Chronic and remitted SI may represent particularly high-risk SI courses; the former was associated with higher rates of prospective SA, and psychiatric and physical distress, and the latter with increased likelihood of prior SA, and isolation from social and mental health supports. Physical disability, MDD/PTSD, and recent stressors may be important precipitating or maintaining factors of SI, while social connectedness may be a key target for suicide prevention efforts.