Risk Factors, Methods, and Timing of Suicide Attempts Among US Army Soldiers
Risk Factors, Methods, and Timing of Suicide Attempts Among US Army Soldiers
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DOI：
10.1001/jamapsychiatry.2016.0600
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发表时间：
2016-07-01
期刊：
影响因子：
25.8
通讯作者：
Heeringa, Steven G.
中科院分区：
文献类型：
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作者：
Ursano, Robert J.;Kessler, Ronald C.;Heeringa, Steven G.
重要性：在过去的十年里，美国军队中的自杀企图有所上升。了解自杀企图和部署之间的关系，以及自杀企图的方法和时机，可以帮助制定干预措施。目的研究在本研究进行时，现役、曾服役和从未服役的士兵中自杀企图的危险因素、方法和时间。设计、环境和参与者本研究对2004年至2009年现役正规军士兵进行了纵向、回顾性队列研究，采用个人水平的人月记录，通过部署状态（从未、目前和以前部署）检查自杀企图的风险因素（社会人口统计学、服役相关和心理健康）、方法和时间。使用离散时间生存框架分析9650例自杀未遂事件前一个月的管理数据和其他士兵153 528例控制人月的等概率样本。主要结局和测量方法从行政和医疗记录中获得自杀企图和职业、心理健康以及人口统计学预测因素。结果9650名企图自杀的士兵中，86.3%为男性，68.4%为30岁以下，59.8%为非西班牙裔白人，76.5%为高中学历，54.7%为已婚。未服役士兵占40.4% （n = 12 421 294人月），自杀未遂士兵占61.1% （n = 5894例）。从未部署的人员的风险在服务的第二个月最高（每10万人月103人）。首次部署的士兵的风险在部署的第六个月最高（每10万人月25人）。对于以前部署的人员，风险在返回后5个月最高（每10万人月40人）。目前和以前部署的士兵比从未部署的士兵更有可能使用枪支自杀（目前部署的：OR， 4.0; 95% CI, 2.9-5.6；以前部署的：OR， 2.7; 95% CI, 1.8-3.9）。从部署状态来看，女性士兵（目前部署：OR， 3.4; 95% CI, 3.0-4.0；以前部署：OR， 1.5; 95% CI, 1.4-1.7；从未部署：OR， 2.4; 95% CI, 2.3-2.6）在服役的前2年(目前部署：OR， 1.9; 95% CI, 1.5-2.3；以前部署：OR， 2.2; 95% CI, 1.9-2.7；从未部署：OR， 3.1；95% CI, 2.7-3.6)，并且最近在上个月接受过精神健康诊断（目前部署：OR， 29.8; 95% CI, 25.0-35.5；以前部署：OR， 22.2; 95% CI, 20.1-24.4；从未部署：OR， 15.0; 95% CI, 14.2-16.0）。在有过一次服役经历的士兵中，从服役返回后，特别是在服役后约4至6个月的随访筛查中，抑郁症或创伤后应激障碍筛查呈阳性的士兵自杀企图的几率更高（抑郁症：or， 1.4; 95% CI, 1.1-1.9；创伤后应激障碍：or， 2.4; 95% CI, 2.1-2.8）。结论和相关性确定士兵自杀企图的时间和危险因素需要考虑环境背景、个体特征和心理健康。这些因素可以为预防工作提供信息。
IMPORTANCE Suicide attempts in the US Army have risen in the past decade. Understanding the association between suicide attempts and deployment, as well as method and timing of suicide attempts, can assist in developing interventions.OBJECTIVE To examine suicide attempt risk factors, methods, and timing among soldiers currently deployed, previously deployed, and never deployed at the time this study was conducted.DESIGN, SETTING, AND PARTICIPANTS This longitudinal, retrospective cohort study of Regular Army-enlisted soldiers on active duty from 2004 through 2009 used individual-level person-month records to examine risk factors (sociodemographic, service related, and mental health), method, and time of suicide attempt by deployment status (never, currently, and previously deployed). Administrative data for the month before each of 9650 incident suicide attempts and an equal-probability sample of 153 528 control person-months for other soldiers were analyzed using a discrete-time survival framework.MAIN OUTCOMES AND MEASURES Suicide attempts and career, mental health, and demographic predictors were obtained from administrative and medical records.RESULTS Of the 9650 enlisted soldiers who attempted suicide, 86.3% were male, 68.4% were younger than 30 years, 59.8% were non-Hispanic white, 76.5% were high school educated, and 54.7% were currently married. The 40.4% of enlisted soldiers who had never been deployed (n = 12 421 294 person-months) accounted for 61.1% of enlisted soldiers who attempted suicide (n = 5894 cases). Risk among those never deployed was highest in the second month of service (103 per 100 000 person-months). Risk among soldiers on their first deployment was highest in the sixth month of deployment (25 per 100 000 person-months). For those previously deployed, risk was highest at 5 months after return (40 per 100 000 person-months). Currently and previously deployed soldiers were more likely to attempt suicide with a firearm than those never deployed (currently deployed: OR, 4.0; 95% CI, 2.9-5.6; previously deployed: OR, 2.7; 95% CI, 1.8-3.9). Across deployment status, suicide attempts were more likely among soldiers who were women (currently deployed: OR, 3.4; 95% CI, 3.0-4.0; previously deployed: OR, 1.5; 95% CI, 1.4-1.7; and never deployed: OR, 2.4; 95% CI, 2.3-2.6), in their first 2 years of service (currently deployed: OR, 1.9; 95% CI, 1.5-2.3; previously deployed: OR, 2.2; 95% CI, 1.9-2.7; and never deployed: OR, 3.1; 95% CI, 2.7-3.6), and had a recently received a mental health diagnosis in the previous month (currently deployed: OR, 29.8; 95% CI, 25.0-35.5; previously deployed: OR, 22.2; 95% CI, 20.1-24.4; and never deployed: OR, 15.0; 95% CI, 14.2-16.0). Among soldiers with 1 previous deployment, odds of a suicide attempt were higher for those who screened positive for depression or posttraumatic stress disorder after return from deployment and particularly at follow-up screening, about 4 to 6 months after deployment (depression: OR, 1.4; 95% CI, 1.1-1.9; posttraumatic stress disorder: OR, 2.4; 95% CI, 2.1-2.8).CONCLUSIONS AND RELEVANCE Identifying the timing and risk factors for suicide attempt in soldiers requires consideration of environmental context, individual characteristics, and mental health. These factors can inform prevention efforts.