Suicide mortality-among individuals receiving treatment for depression in the veterans affairs health system: Associations with patient and treatment setting characteristics
Suicide mortality-among individuals receiving treatment for depression in the veterans affairs health system: Associations with patient and treatment setting characteristics
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DOI：
10.2105/ajph.2007.115477
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发表时间：
2007-12-01
影响因子：
12.7
通讯作者：
Valenstein, Marcia
中科院分区：
文献类型：
--
作者：
Zivin, Kara;Kim, Myra;Valenstein, Marcia
目标.我们试图报告与抑郁症退伍军人自杀相关的临床和人口统计学因素，以确定哪些特征识别抑郁症退伍军人自杀的高风险。我们使用纵向的全国代表性数据（1999-2004）来确定抑郁症退伍军人的自杀率，使用考克斯比例风险回归模型估计自杀时间。在符合研究标准的807694名退伍军人中，1683人（0.21%）在随访期间自杀。在男性、年轻人和非西班牙裔白色患者中观察到自杀风险增加。没有服务相关残疾的退伍军人，在他们合格的抑郁症诊断前一年住院精神病住院治疗，患有共病物质使用，以及生活在美国南部或西部的风险也较高。创伤后应激障碍（PTSD）与抑郁症共病者自杀率较低，年轻的抑郁症退伍军人与PTSD相比，自杀率较高。与一般人群不同，年长和年轻的退伍军人比中年退伍军人更容易自杀。未来的研究应该检查退伍军人中抑郁症，创伤后应激障碍，医疗服务使用和自杀风险之间的关系。
Objectives. We sought to report clinical and demographic factors associated with suicide among depressed veterans in an attempt to determine what characteristics identified depressed veterans at high risk for suicide.Methods. We used longitudinal, nationally representative data (1999-2004) to determine suicide rates among depressed veterans, estimating time until suicide using Cox proportional hazards regression models.Results. Of 807 694 veterans meeting study criteria, 1683 (0.21%) committed suicide during follow-up. Increased suicide risks were observed among male, younger, and non-Hispanic White patients. Veterans without service-connected disabilities, with inpatient psychiatric hospitalizations in the year prior to their qualifying depression diagnosis, with comorbid substance use, and living in the southern or western United States were also at higher risk. Posttraumatic stress disorder (PTSD) with comorbid depression was associated with lower suicide rates, and younger depressed veterans with PTSD had a higher suicide rate than did older depressed veterans with PTSD.Conclusions. Unlike the general population, older and younger veterans are more prone to suicide than are middle-aged veterans. Future research should examine the relationship between depression, PTSD, health service use, and suicide risks among veterans.