Intentional Self-Harm Among US Veterans With Traumatic Brain Injury or Posttraumatic Stress Disorder: Retrospective Cohort Study From 2008 to 2017.
Intentional Self-Harm Among US Veterans With Traumatic Brain Injury or Posttraumatic Stress Disorder: Retrospective Cohort Study From 2008 to 2017.
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DOI：
10.2196/42803
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发表时间：
2023-07-24
影响因子：
8.5
通讯作者：
Carlson, F.
中科院分区：
文献类型：
--
作者：
Rawat, Bhanu Pratap Singh;Reisman, Joel;Pogoda, Terri K.;Liu, Weisong;Rongali, Subendhu;Aseltine, Robert H.;Chen, Kun;Tsai, Jack;Berlowitz, Dan;Yu, Hong;Carlson, F.
与没有 TBI 或 PTSD 的退伍军人相比，有创伤性脑损伤 (TBI) 和/或创伤后应激障碍 (PTSD) 病史的退伍军人自杀未遂和其他形式的故意自残的风险可能更高。利用美国退伍军人健康管理局 (VHA) 的管理数据，我们研究了 2008 年至 2017 年间使用 VHA 医疗保健的美国退伍军人中 TBI 和 PTSD 诊断以及随后的故意自残诊断之间的关联。所有因故意自残而遭遇或住院的退伍军人都被分配了与第一次相关就诊日期相对应的“索引日期”；在那些没有故意自残的人中，我们从退伍军人的医疗保健经历中随机选择一个日期，以匹配 10 年来病例索引日期的分布。然后，我们检查了退伍军人指数日期之前 5 年内 TBI 和 PTSD 诊断的患病率。使用国际疾病分类诊断和住院和门诊 VHA 遭遇的外因伤害代码来识别 TBI、PTSD 和故意自残。我们根据退伍军人在索引日期之前 5 年内的年平均 VHA 使用率（低、中或高）进行了分层分析。根据退伍军人之前的 TBI 和 PTSD 诊断状态（仅 TBI、仅 PTSD 和共病 TBI/PTSD），对每个 VHA 使用层的故意自残诊断的患病率和几率的变化进行比较。多变量模型根据年龄、性别、种族、民族、婚姻状况、退伍军人事务部服务连接状态和查尔森合并症指数评分进行调整。分析中纳入了约 670 万退伍军人，他们在索引日期之前的 5 年内至少接受过两次 VHA 访问；在研究期间，86,644 人被诊断出至少有一次故意自残。在退伍军人指数日期之前的一段时间内，有 93,866 人被诊断出仅患有 TBI； 892,420 仅患有 PTSD； 102,549 人患有 TBI/PTSD 共病。在所有三个 VHA 使用层中，被诊断患有 TBI、PTSD 或 TBI/PTSD 的退伍军人中故意自残诊断的患病率高于没有诊断的退伍军人。所观察到的差异在 VHA 高利用率阶层的退伍军人中最为明显。患有 TBI/PTSD 的退伍军人（6778/58,295，11.63%）中故意自残的发生率是既没有 TBI 也没有 PTSD 的退伍军人（21,979/1,144,991，1.92%）的六倍。调整后的比值比表明，在考虑了潜在的混杂因素后，患有 TBI、PTSD 或共病 TBI/PTSD 的退伍军人比没有这些诊断的退伍军人有更高的自残几率。在 VHA 使用率高的退伍军人中，患有 TBI/PTSD 共病的退伍军人被诊断为故意自残的可能性是没有诊断的退伍军人的 4.26 倍（95% CI 4.15-4.38）。对于 VHA 利用率较低和中等的退伍军人来说，这种模式是相似的。 2008 年至 2017 年间，与没有诊断过的退伍军人相比，患有 TBI 和/或 PTSD 诊断的退伍军人随后被诊断为故意自残的可能性要大得多。这些关联在最频繁使用 VHA 医疗保健的退伍军人中最为明显。这些发现表明需要针对患有这些诊断的退伍军人开展自杀预防工作。
Veterans with a history of traumatic brain injury (TBI) and/or posttraumatic stress disorder (PTSD) may be at increased risk of suicide attempts and other forms of intentional self-harm as compared to veterans without TBI or PTSD. Using administrative data from the US Veterans Health Administration (VHA), we studied associations between TBI and PTSD diagnoses, and subsequent diagnoses of intentional self-harm among US veterans who used VHA health care between 2008 and 2017. All veterans with encounters or hospitalizations for intentional self-harm were assigned “index dates” corresponding to the date of the first related visit; among those without intentional self-harm, we randomly selected a date from among the veteran’s health care encounters to match the distribution of case index dates over the 10-year period. We then examined the prevalence of TBI and PTSD diagnoses within the 5-year period prior to veterans’ index dates. TBI, PTSD, and intentional self-harm were identified using International Classification of Diseases diagnosis and external cause of injury codes from inpatient and outpatient VHA encounters. We stratified analyses by veterans’ average yearly VHA utilization in the 5-year period before their index date (low, medium, or high). Variations in prevalence and odds of intentional self-harm diagnoses were compared by veterans’ prior TBI and PTSD diagnosis status (TBI only, PTSD only, and comorbid TBI/PTSD) for each VHA utilization stratum. Multivariable models adjusted for age, sex, race, ethnicity, marital status, Department of Veterans Affairs service-connection status, and Charlson Comorbidity Index scores. About 6.7 million veterans with at least two VHA visits in the 5-year period before their index dates were included in the analyses; 86,644 had at least one intentional self-harm diagnosis during the study period. During the periods prior to veterans’ index dates, 93,866 were diagnosed with TBI only; 892,420 with PTSD only; and 102,549 with comorbid TBI/PTSD. Across all three VHA utilization strata, the prevalence of intentional self-harm diagnoses was higher among veterans diagnosed with TBI, PTSD, or TBI/PTSD than among veterans with neither diagnosis. The observed difference was most pronounced among veterans in the high VHA utilization stratum. The prevalence of intentional self-harm was six times higher among those with comorbid TBI/PTSD (6778/58,295, 11.63%) than among veterans with neither TBI nor PTSD (21,979/1,144,991, 1.92%). Adjusted odds ratios suggested that, after accounting for potential confounders, veterans with TBI, PTSD, or comorbid TBI/PTSD had higher odds of self-harm compared to veterans without these diagnoses. Among veterans with high VHA utilization, those with comorbid TBI/PTSD were 4.26 (95% CI 4.15-4.38) times more likely to receive diagnoses for intentional self-harm than veterans with neither diagnosis. This pattern was similar for veterans with low and medium VHA utilization. Veterans with TBI and/or PTSD diagnoses, compared to those with neither diagnosis, were substantially more likely to be subsequently diagnosed with intentional self-harm between 2008 and 2017. These associations were most pronounced among veterans who used VHA health care most frequently. These findings suggest a need for suicide prevention efforts targeted at veterans with these diagnoses.
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影响因子：
10.5
作者：
Iversen, Amy C.;van Staden, Lauren;Fear, Nicola T.
通讯作者：
Fear, Nicola T.
影响因子：
3.3
作者：
Jakupcak, Matthew;Cook, Jessica;McFall, Miles
通讯作者：
McFall, Miles
影响因子：
2.4
作者：
Kelley, Elizabeth;Sullivan, Campbell;Poole, John H.
通讯作者：
Poole, John H.
DOI：
10.1037/tra0000035
发表时间：
2015-11-01
期刊：
Psychological trauma : theory, research, practice and policy
影响因子：
--
作者：
Hundt, Natalie E;Mott, Juliette M;Stanley, Melinda A
通讯作者：
Stanley, Melinda A
影响因子：
1.9
作者：
Carlson, Kathleen F.;Barnes, Joan E.;Sayer, Nina A.
通讯作者：
Sayer, Nina A.