Occupational differences in US Army suicide rates.
Occupational differences in US Army suicide rates.
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DOI：
10.1017/s0033291715001294
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发表时间：
2015-11
影响因子：
6.9
通讯作者：
Ursano RJ
中科院分区：
文献类型：
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作者：
Kessler RC;Stein MB;Bliese PD;Bromet EJ;Chiu WT;Cox KL;Colpe LJ;Fullerton CS;Gilman SE;Gruber MJ;Heeringa SG;Lewandowski-Romps L;Millikan-Bell A;Naifeh JA;Nock MK;Petukhova MV;Rosellini AJ;Sampson NA;Schoenbaum M;Zaslavsky AM;Ursano RJ
平民自杀率因职业而异，其方式与职业压力暴露有关。可比较的军事研究发现，战斗武器职业的自杀率上升。然而，没有研究通过部署历史来评估这种模式的变化，这一职业压力指标被广泛认为是最近军事自杀率上升的原因。在2004年至2009年期间，美国陆军729337名男性正规军士兵的管理数据集中，分析了军队职业和部署历史在预测自杀方面的联合关联。在研究期间有496人自杀（22.4/10万人年）。只有两个职业类别（都是在战斗部队）的自杀率显著升高：步兵（37.2/10万人-年）和战斗工兵（38.2/10万人-年）。然而，这两类士兵的自杀率在目前部署时（30.6/10万人年）显著低于从未部署或以前部署时（41.2 - 39.1/10万人年），而其他士兵的自杀率在目前部署和以前部署时（20.2 - 22.4/10万人年）显著高于从未部署时（14.5/10万人年）。导致调整后的步兵和工兵自杀率在从未部署时最高[比值比（OR） 2.9, 95%置信区间（CI） 2.1-4.1]，以前部署时较少（OR 1.6, 95% CI 1.1-2.1），而当前部署时则完全没有（OR 1.2, 95% CI 0.8-1.8）。调整不同的“健康战士效应”并不能解释从未部署过的步兵和战斗工兵的相对自杀率随部署状态的变化。需要努力阐明这种相互作用的因果机制，以指导对高自杀风险士兵的预防干预。
Civilian suicide rates vary by occupation in ways related to occupational stress exposure. Comparable military research finds suicide rates elevated in combat arms occupations. However, no research has evaluated variation in this pattern by deployment history, the indicator of occupation stress widely considered responsible for the recent rise in the military suicide rate. The joint associations of Army occupation and deployment history in predicting suicides were analysed in an administrative dataset for the 729 337 male enlisted Regular Army soldiers in the US Army between 2004 and 2009. There were 496 suicides over the study period (22.4/100 000 person-years). Only two occupational categories, both in combat arms, had significantly elevated suicide rates: infantrymen (37.2/100 000 person-years) and combat engineers (38.2/100 000 person-years). However, the suicide rates in these two categories were significantly lower when currently deployed (30.6/100 000 person-years) than never deployed or previously deployed (41.2–39.1/100 000 person-years), whereas the suicide rate of other soldiers was significantly higher when currently deployed and previously deployed (20.2–22.4/100 000 person-years) than never deployed (14.5/100 000 person-years), resulting in the adjusted suicide rate of infantrymen and combat engineers being most elevated when never deployed [odds ratio (OR) 2.9, 95% confidence interval (CI) 2.1–4.1], less so when previously deployed (OR 1.6, 95% CI 1.1–2.1), and not at all when currently deployed (OR 1.2, 95% CI 0.8–1.8). Adjustment for a differential ‘healthy warrior effect’ cannot explain this variation in the relative suicide rates of never-deployed infantrymen and combat engineers by deployment status. Efforts are needed to elucidate the causal mechanisms underlying this interaction to guide preventive interventions for soldiers at high suicide risk.