Risk Factors Associated With Suicide in Current and Former US Military Personnel
Risk Factors Associated With Suicide in Current and Former US Military Personnel
复制标题
DOI：
10.1001/jama.2013.65164
复制
发表时间：
2013-08-07
影响因子：
120.7
通讯作者：
Hoge, Charles W.
中科院分区：
文献类型：
--
作者：
LeardMann, Cynthia A.;Powell, Teresa M.;Hoge, Charles W.
从2005年开始，美军自杀死亡的发生率开始急剧上升。独特的压力因素，如战斗部署，被认为是发病率上升的基础。然而，以前的军队自杀研究依赖于病例系列和横断面调查，并没有将服役期间的数据与服役后的数据联系起来。目的前瞻性地识别和量化与现任和前任美国军人自杀相关的危险因素，包括人口统计、军事、心理健康、行为和部署特征。设计、设置和参与者前瞻性纵向研究，对2001、2004和2007年的参与者进行评估和评估。问卷数据与国家死亡指数和国防部医疗死亡登记联系在一起，直到2008年12月31日。研究对象为所有军种的现役和退役美国军人，包括现役军人和预备役军人/国民警卫队，他们被纳入千年队列研究(N=151 560)。主要结果和衡量自杀死亡的指标由国家死亡指数和国防部医疗死亡登记获得。结果截至2008年底，在707 493人年的随访中，结果为83人自杀(11.73/10万人年[95%CI，9.21-14.26])。在调整了年龄和性别的Cox模型中，与自杀风险增加显著相关的因素包括男性、抑郁症、躁郁症、酗酒或酗酒以及与酒精相关的问题。在任何模型中，与部署相关的因素(战斗经验、累计部署天数或部署数量)均与自杀风险增加无关。在多变量COX模型中，自杀风险增加的个体为男性(危险比，2.14；95%CI，1.17-3.92；P=.01；归因风险[AR]，3.5例/10,000人)，以及抑郁症(HR，1.96；95%CI，1.05-3.64；P=.03；AR，6.9/10,000人)、躁狂抑郁障碍(HR，4.35；95%CI，1.56-12.09；P=.005；或与酒精有关的问题(HR，2.56；95%CI，1.56-4.18；P<；.001；AR，7.7/10000人)。一项嵌套的配对病例对照分析证实了这些发现。结论在2001年7月1日至2008年12月31日观察到的现役和退役军人样本中，自杀风险与男性性别和精神障碍独立相关，但与军人特有的变量无关。这些发现可能会为减轻这一人群中自杀风险的方法提供参考。
IMPORTANCE Beginning in 2005, the incidence of suicide deaths in the US military began to sharply increase. Unique stressors, such as combat deployments, have been assumed to underlie the increasing incidence. Previous military suicide studies, however, have relied on case series and cross-sectional investigations and have not linked data during service with postservice periods.OBJECTIVE To prospectively identify and quantify risk factors associated with suicide in current and former US military personnel including demographic, military, mental health, behavioral, and deployment characteristics.DESIGN, SETTING, AND PARTICIPANTS Prospective longitudinal study with accrual and assessment of participants in 2001, 2004, and 2007. Questionnaire data were linked with the National Death Index and the Department of Defense Medical Mortality Registry through December 31, 2008. Participants were current and former US military personnel from all service branches, including active and Reserve/National Guard, who were included in the Millennium Cohort Study (N = 151 560).MAIN OUTCOMES AND MEASURES Death by suicide captured by the National Death Index and the Department of Defense Medical Mortality Registry.RESULTS Through the end of 2008, findings were 83 suicides in 707 493 person-years of follow-up (11.73/100 000 person-years [95% CI, 9.21-14.26]). In Cox models adjusted for age and sex, factors significantly associated with increased risk of suicide included male sex, depression, manic-depressive disorder, heavy or binge drinking, and alcohol-related problems. None of the deployment-related factors (combat experience, cumulative days deployed, or number of deployments) were associated with increased suicide risk in any of the models. In multivariable Cox models, individuals with increased risk for suicide were men (hazard ratio [HR], 2.14; 95% CI, 1.17-3.92; P = .01; attributable risk [AR], 3.5 cases/10 000 persons), and those with depression (HR, 1.96; 95% CI, 1.05-3.64; P = .03; AR, 6.9/10 000 persons), manic-depressive disorder (HR, 4.35; 95% CI, 1.56-12.09; P = .005; AR, 35.6/10 000 persons), or alcohol-related problems (HR, 2.56; 95% CI, 1.56-4.18; P < .001; AR, 7.7/10 000 persons). A nested, matched case-control analysis using 20: 1 control participants per case confirmed these findings.CONCLUSIONS AND RELEVANCE In this sample of current and former military personnel observed July 1, 2001-December 31, 2008, suicide risk was independently associated with male sex and mental disorders but not with military-specific variables. These findings may inform approaches to mitigating suicide risk in this population.