Association of Premilitary Mental Health With Suicide Attempts During US Army Service.
Association of Premilitary Mental Health With Suicide Attempts During US Army Service.
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DOI：
10.1001/jamanetworkopen.2022.14771
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发表时间：
2022-06-01
影响因子：
13.8
通讯作者：
Kessler, Ronald C.
中科院分区：
文献类型：
--
作者：
Naifeh, James A.;Ursano, Robert J.;Stein, Murray B.;Mash, Holly B. Herberman;Aliaga, Pablo A.;Fullerton, Carol S.;Dinh, Hieu M.;Kao, Tzu-Cheg;Sampson, Nancy A.;Kessler, Ronald C.
在自杀未遂前没有接受心理健康诊断的士兵中，军事前心理健康与自杀未遂相关吗？这项对21772名正规军士兵的队列研究发现，对于那些接受和没有接受心理健康诊断的人来说，自杀未遂风险在服役第一年结束时达到顶峰。两组的军事前心理健康危险因素不同。这项研究的结果表明，时间进程和入伍前的心理健康状况可能有助于确定自杀企图的风险，在士兵和没有心理健康诊断。大约三分之一的美国士兵谁企图自杀（SA）之前没有收到心理健康诊断（MH-Dx），但很少有人知道SA的危险因素在那些没有MH-Dx。研究是否军事前心理健康与医学记录的SA在美国陆军士兵谁不接受MH-Dx之前，他们的SA。这项队列研究使用的数据来自美国陆军从2011年4月1日至2012年11月30日参加基本战斗训练的士兵的代表性调查，这些士兵通过服役前48个月的行政记录进行随访。分析于2021年4月5日至2022年1月21日进行。常规陆军入伍士兵（n = 21 772）招募3美国陆军设施在第一周的服务谁同意有他们的行政记录链接到他们的调查响应。基线调查期间报告的入伍前精神障碍、自杀意念、SA和非自杀性自伤（NSSI）终身史。使用行政记录确定服务获得的MH-Dx和社会人口统计学及服务相关变量。使用行政医疗记录识别记录的SA。使用离散时间生存框架，线性样条检查SA风险的模式在第一个48个月的服务。Logistic回归分析研究了终身基线调查变量与随后的相关性，在服役期间接受与未接受MH-Dx的士兵中，有医学记录的SA。模型进行了调整的时间在服务和社会人口和服务相关的变量。在21，722名受访者中（86.2%为男性，20.4%为黑人，61.8%为非西班牙裔白色人），253人在服役的前48个月内获得了SA（男性[75.4%];黑人[22.7%]、非西班牙裔白色人[59.9%]或其他种族或民族[17.4%]）。SA的风险在服役第一年结束时达到峰值，无论是在服役期间接受还是未接受MH-Dx。在42.3%报告至少有4种基线风险因素之一的个体中，50.2%在服务期间接受了管理MH-Dx，而41.5%的人没有接受管理MH-Dx，1.6%的人有记录的SA，而1.0%的人没有接受管理MH-Dx。在没有MH-Dx的个体中，医学记录的SA与自杀意念（比值比[OR]，2.2; 95%CI，1.1 - 4.4）、SA（OR，11.3; 95%CI，4.3 - 29.2）和NSSI（OR，3.0; 95%CI，1.3 - 6.8）相关。对于接受MH-Dx的患者，医学记录的SA与精神障碍（OR，1.4; 95%CI，1.0 - 1.9）、SA（OR，3.4; 95%CI，2.1 - 5.6）和NSSI（OR，1.8; 95%CI，1.1 - 2.8）相关。相互作用表明，唯一的解释变量，不同的基础上的历史MH-Dx是入伍前SA（χ 21 = 4.7; P = 0.03），其中有一个更大的OR之间的士兵没有MH-Dx比那些与MH-Dx。在这项研究中，SA的最大风险期和基线风险因素在有和没有MH-Dx的士兵中是相似的。这一发现表明，时间过程和入伍前心理健康因素的知识，同样可以帮助确定SA风险的士兵谁不接受MH-Dx。这项队列研究评估了在服役期间未接受心理健康诊断的美国陆军士兵中，入伍前接受心理健康诊断与医学记录的自杀企图之间的关联。
Is premilitary mental health associated with suicide attempts among soldiers who do not receive a mental health diagnosis before their suicide attempt? This cohort study of 21 772 Regular Army enlisted soldiers found that suicide attempt risk peaked at the end of the first year of service for those who did and did not receive a mental health diagnosis. Premilitary mental health risk factors differed in the 2 groups. The findings of this study suggest that time course and preenlistment mental health status may aid in identifying suicide attempt risk in soldiers with and without a mental health diagnosis. Approximately one-third of US soldiers who attempt suicide have not received a mental health diagnosis (MH-Dx) before their suicide attempt (SA), yet little is known about risk factors for SA in those with no MH-Dx. To examine whether premilitary mental health is associated with medically documented SA among US Army soldiers who do not receive an MH-Dx before their SA. This cohort study used data from a representative survey of soldiers in the US Army entering basic combat training from April 1, 2011, to November 30, 2012, who were followed up via administrative records for the first 48 months of service. Analyses were conducted from April 5, 2021, to January 21, 2022. Regular Army enlisted soldiers (n = 21 772) recruited from 3 US Army installations during the first week of service who agreed to have their administrative records linked to their survey responses were included. Preenlistment lifetime history of mental disorder, suicide ideation, SA, and nonsuicidal self-injury (NSSI) as reported during the baseline survey. Service-acquired MH-Dx and sociodemographic and service-related variables were identified using administrative records. Documented SAs were identified using administrative medical records. Using a discrete-time survival framework, linear splines examined the pattern of SA risk over the first 48 months of service. Logistic regression analysis examined associations of lifetime baseline survey variables with subsequent, medically documented SA among soldiers who did vs did not receive an MH-Dx during service. Models were adjusted for time in service and sociodemographic and service-related variables. Of the 21 722 respondents (86.2% male, 20.4% Black, 61.8% White non-Hispanic), 253 made an SA in the first 48 months of service (male [75.4%]; Black [22.7%], White non-Hispanic [59.9%], or other race or ethnicity [17.4%]). Risk of SA peaked toward the end of the first year of service for both those who did and did not receive an MH-Dx during service. Of the 42.3% of individuals reporting at least 1 of the 4 baseline risk factors, 50.2% received an administrative MH-Dx during service vs 41.5% of those with none, and 1.6% had a documented SA vs 1.0% of those with none. Among individuals with no MH-Dx, medically documented SAs were associated with suicide ideation (odds ratio [OR], 2.2; 95% CI, 1.1-4.4), SA (OR, 11.3; 95% CI, 4.3-29.2), and NSSI (OR, 3.0; 95% CI, 1.3-6.8). For those who received an MH-Dx, medically documented SAs were associated with mental disorder (OR, 1.4; 95% CI, 1.0-1.9), SA (OR, 3.4; 95% CI, 2.1-5.6), and NSSI (OR, 1.8; 95% CI, 1.1-2.8). Interactions indicated the only explanatory variable that differed based on history of MH-Dx was preenlistment SA (χ21 = 4.7; P = .03), which had a larger OR among soldiers with no MH-Dx than among those with an MH-Dx. In this study, the period of greatest SA risk and baseline risk factors for SA were similar in soldiers with and without an MH-Dx. This finding suggests that knowledge of the time course and preenlistment mental health factors can equally aid in identifying SA risk in soldiers who do and do not receive an MH-Dx. This cohort study assesses the association between receiving a mental health diagnosis prior to enlistment and medically documented suicide attempt among current US Army soldiers who have not received a mental health diagnosis during their service.
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影响因子：
6.9
作者：
Ribeiro JD;Franklin JC;Fox KR;Bentley KH;Kleiman EM;Chang BP;Nock MK
通讯作者：
Nock MK
影响因子：
7.4
作者：
Rosellini, Anthony J.;Heeringa, Steven G.;Kessler, Ronald C.
通讯作者：
Kessler, Ronald C.
影响因子：
6.9
作者：
Nock MK;Dempsey CL;Aliaga PA;Brent DA;Heeringa SG;Kessler RC;Stein MB;Ursano RJ;Benedek D
通讯作者：
Benedek D
影响因子：
25.8
作者：
Ursano, Robert J.;Kessler, Ronald C.;Heeringa, Steven G.
通讯作者：
Heeringa, Steven G.
影响因子：
3.1
作者：
Kessler, Ronald C.;Heeringa, Steven G.;Colpe, Lisa J.;Fullerton, Carol S.;Gebler, Nancy;Hwang, Irving;Naifeh, James A.;Nock, Matthew K.;Sampson, Nancy A.;Schoenbaum, Michael;Zaslavsky, Alan M.;Stein, Murray B.;Ursano, Robert J.
通讯作者：
Ursano, Robert J.