Pre-enlistment Anger Attacks and Postenlistment Mental Disorders and Suicidality Among US Army Soldiers.
Pre-enlistment Anger Attacks and Postenlistment Mental Disorders and Suicidality Among US Army Soldiers.
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DOI：
10.1001/jamanetworkopen.2021.26626
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发表时间：
2021-09-01
影响因子：
13.8
通讯作者：
Army STARRS Team
中科院分区：
文献类型：
--
作者：
Smith DM;Meruelo A;Campbell-Sills L;Sun X;Kessler RC;Ursano RJ;Jain S;Stein MB;Army STARRS Team
入伍前的愤怒发作史是否与入伍后精神障碍和自杀的新发和持续有关？在一项对38507名新兵的队列研究中，入伍前的破坏性愤怒攻击史（即导致生活干扰的攻击）与入伍后发生的重度抑郁症、广泛性焦虑症（GAD）、恐慌症和自杀意念显著相关。这些关联部分可以用精神共病来解释；然而，破坏性愤怒发作与广泛性焦虑症的新发和自杀意念独立相关。这些发现表明，对破坏性愤怒攻击的检测可以帮助评估入伍后患焦虑症、抑郁症和自杀的高风险。本队列研究使用美国陆军STARRS新兵研究的数据，调查入伍前的愤怒发作是否与入伍后精神障碍和自杀的新发病和持续有关。在军人群体中，愤怒与不良后果有关；然而，入伍前的愤怒攻击是否与入伍后的精神障碍和自杀有关尚不清楚。目的探讨入伍前愤怒发作与入伍后心理健康的关系。在这项观察性队列研究中，陆军评估服务人员风险和弹性研究（陆军STARRS）新兵研究（NSS）调查了2011年4月至2012年11月进入基础训练的士兵，并为STARRS纵向研究（STARRS- ls）的第一波招募了一个子样本（2016年9月至2018年4月）。参与者是从3个美国陆军基地招募来进行NSS调查的。那些随后被联系进行STARRS-LS的人通过网络或电话完成了后续调查。前瞻性分析基于STARRS-LS波1中包含的加权NSS子样本。数据分析时间为2020年5月22日至2021年3月17日。基线愤怒发作史（NSS）。调查结果被用来将新兵分为非减损性愤怒发作（> - 2发作，不干扰工作或个人生活）、减损性愤怒发作（> - 2发作，干扰工作或个人生活）或无显著的愤怒发作史。基线分析检查了愤怒发作史的社会人口学和临床相关性。前瞻性logistic回归模型估计了基线愤怒发作史与创伤后应激障碍、重度抑郁症（MDD）、广广性焦虑症（GAD）、惊恐障碍、躁狂/轻躁狂、物质使用障碍、自杀意念和自杀企图在STARRS-LS波1中的关联。在38507名基线参与者中（83.0%为男性，17.0%为女性，平均[SD]年龄为20.97[3.57]岁），6216人被选中参加并完成STARRS-LS第1波。无减损性和减损性愤怒发作的基线患病率（SE）分别为8.83%（0.16%）和5.75%（0.15%）。前瞻性模型显示，减损性愤怒发作与新发MDD（调整优势比[AOR]， 1.98; 95% CI, 1.31-2.99）、GAD （AOR, 2.39; 95% CI, 1.66-3.45）、惊恐障碍（AOR, 2.02; 95% CI, 1.34-3.05）和自杀意念（AOR, 2.11; 95% CI, 1.45-3.07）相关。当基线精神合并症得到控制时，损害性发作仍然与广泛性焦虑症（AOR, 1.75; 95% CI, 1.19-2.58）和自杀意念（AOR, 1.62; 95% CI, 1.09-2.42）的发作相关。愤怒发作与入伍前精神障碍的持续存在没有显著关联。本研究的结果表明，入伍前的破坏性愤怒发作史可能与入伍后患广泛性焦虑症、重度抑郁症和自杀的风险增加有关。对破坏性愤怒发作的检测有助于评估新兵的精神风险。
Is a history of anger attacks before enlistment associated with new onset and persistence of mental disorders and suicidality after enlistment among new US Army soldiers? In a cohort study of 38 507 new soldiers, a pre-enlistment history of impairing anger attacks (ie, attacks causing life interference) was significantly associated with postenlistment onset of major depression, generalized anxiety disorder (GAD), panic disorder, and suicidal ideation. These associations were partly explained by psychiatric comorbidity; however, impairing anger attacks were independently associated with new onset of GAD and suicidal ideation. These findings suggest that detection of impairing anger attacks could aid in assessing elevated risk of developing anxiety disorders, depression, and suicidality after enlistment. This cohort study uses data from the Army STARRS New Soldier Study to investigate whether pre-enlistment anger attacks are associated with new onset and persistence of mental disorders and suicidality after enlistment in a US Army sample. Anger is linked to adverse outcomes in military populations; however, whether pre-enlistment anger attacks are associated with postenlistment mental disorders and suicidality is unknown. To explore the associations of pre-enlistment anger attacks with postenlistment mental health. In this observational cohort study, the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) New Soldier Study (NSS) surveyed soldiers entering basic training from April 2011 to November 2012, with a subsample recruited for wave 1 of the STARRS Longitudinal Study (STARRS-LS) (conducted September 2016 to April 2018). Participants were recruited from 3 US Army installations for the NSS survey. Those who were subsequently contacted for STARRS-LS completed the follow-up survey via web or telephone. Prospective analyses were based on a weighted NSS subsample included in wave 1 of STARRS-LS. Data were analyzed from May 22, 2020, to March 17, 2021. History of anger attacks at baseline (NSS). Survey responses were used to classify new soldiers as having nonimpairing anger attacks (>2 attacks without interference in work or personal life), impairing anger attacks (>2 attacks with interference in work or personal life), or no significant history of anger attacks. Baseline analyses examined sociodemographic and clinical correlates of a history of anger attacks. Prospective logistic regression models estimated associations of baseline history of anger attacks with new onset and persistence of posttraumatic stress disorder, major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder, mania/hypomania, substance use disorder, suicidal ideation, and suicide attempt at wave 1 of STARRS-LS. Of the 38 507 baseline participants (83.0% male and 17.0% female; mean [SD] age, 20.97 [3.57] years), 6216 were selected for and completed wave 1 of the STARRS-LS. Baseline prevalence (SE) of nonimpairing and impairing anger attacks was 8.83% (0.16%) and 5.75% (0.15%), respectively. Prospective models showed that impairing anger attacks were associated with new onset of MDD (adjusted odds ratio [AOR], 1.98; 95% CI, 1.31-2.99), GAD (AOR, 2.39; 95% CI, 1.66-3.45), panic disorder (AOR, 2.02; 95% CI, 1.34-3.05), and suicidal ideation (AOR, 2.11; 95% CI, 1.45-3.07). When baseline psychiatric comorbidity was controlled for, impairing attacks remained associated with onset of GAD (AOR, 1.75; 95% CI, 1.19-2.58) and suicidal ideation (AOR, 1.62; 95% CI, 1.09-2.42). Anger attacks were not significantly associated with persistence of pre-enlistment mental disorders. The findings of this study suggest that a pre-enlistment history of impairing anger attacks may be associated with elevated risk of developing GAD, MDD, and suicidality after enlistment. Detection of impairing anger attacks could aid in assessing psychiatric risk in new soldiers.
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影响因子：
7.6
作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
Kessler, R. C.
影响因子：
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作者：
Okuda M;Picazo J;Olfson M;Hasin DS;Liu SM;Bernardi S;Blanco C
通讯作者：
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