Exposure to Suicide Among Post 9/11 Veterans: Prevalence, Correlates and Treatment Needs

9/11 事件后退伍军人的自杀风险：患病率、相关性和治疗需求

• 批准号: 10409976
• 负责人: NINA A. SAYER
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10409976
• 关键词: Address; Affect; Alaska Native; American Indians; Attention; Buffers; Cessation of life; Characteristics; Data; Data Analyses; Data Collection; Death Rate; Diagnosis; Disease; Enrollment; Ethnic Origin; Exposure to; Feeling suicidal; Foundations; Grief reaction; Health; Healthcare; Impairment; Individual; Intervention; Interview; Knowledge; Lead; Life; Mental Health; Mental disorders; Methodology; Methods; Military Personnel; Minority; Outcome; Pattern; Persons; Population; Post-Traumatic Stress Disorders; Prevalence; Prevention strategy; Probability; Probability Samples; Public Health; Race; Recording of previous events; Reporting; Research; Respondent; Risk; Risk Factors; Sample Size; Sampling; Sex Differences; Social Functioning; Social support; Sudden Death; Suicide; Suicide attempt; Suicide prevention; Surveys; Target Populations; Time; Trauma; Veterans; Woman; Work; cohort; combat; comparison group; effective therapy; experience; functional outcomes; healing; health care service; health care service utilization; high risk; informal support; innovation; interest; post 9/11; prevent; primary outcome; racial and ethnic; racial diversity; reducing suicide; research and development; service member; service utilization; sex; social stigma; suicidal behavior; suicidal morbidity; suicidal risk; suicide model; therapy development; virtual

Background: The toll of suicide goes way beyond the death of an individual. Those exposed (defined as knowing the person) to a suicide death are at elevated risk for mental illness, physical disorders, impaired social functioning, and fatal and nonfatal suicide behavior. Conclusions from the handful of studies that have examined this topic among Veterans are limited by distinct samples, limited sample sizes and other methodological issues. Additionally, the numbers of women and minority race/ethnicity service members and Veterans in these studies were too small to examine what are likely critical differences by sex and race. Significance: This study will provide foundational information on an understudied risk factor for suicide in a cohort of Veterans at increased suicide risk – post 9/11 Veterans within six years following military separation. It will provide information to inform suicide postvention strategies that target the population of suicide bereaved post-9/11 Veterans as well as those targeting women and American Indian/Alaskan Native (AI/AN) Veterans. Innovation and Impact: (1) Use of VA data to provide the most reliable prevalence estimates for suicide exposure among Veterans to date; (2) Oversampling of vulnerable but understudied populations -- Women and AI/AN Veterans; (3) inclusion of two comparison groups to elucidate the common and unique contribution of suicide exposure to health outcomes and patterns of VA service utilization; and (4) Assessment of the formal and informal supports Veterans receive for mental health problems associated with suicide using both survey and VA healthcare utilization data. Specific Aims: (1) Evaluate differences in the prevalence of posttraumatic stress disorder (PTSD), prolonged grief disorder (PGD), and in suicidal ideation, attempts and planning among Veterans exposed to suicide compared with those exposed to other causes of sudden death and with unexposed Veterans. We will also evaluate differences by sex and race. (2) Identify modifiable moderating factors for the association between suicide exposure and negative outcomes and modifiable moderating factors for the association between suicide or sudden death exposure and negative outcomes relative to those with neither exposure. (3) Describe treatment experiences, interests, reported suicide attempts, and patterns of VA service utilization among those exposed to a suicide death compared to Veterans exposed to other sudden deaths and to unexposed Veterans. (4) Contextualize quantitative findings through interviews with a purposive sample of Veterans exposed to suicide. The interviews will focus on modifiable factors at each level of the socio-ecological model of suicide prevention to better understand targets for intervention. Methodology: This explanatory sequential mixed methods study examines outcomes associated with suicide exposure in a nationally representative sample of post-9/11 Veterans enrolled in VA healthcare. We will collect data in three waves. Wave 1 will implement a national population probability sample using a brief survey to assess exposure history (suicide, other sudden death, neither) and exposure characteristics (e.g., time since exposure) among 11,400 Veteran respondents. Wave 2 will survey Wave 1 respondents, stratified by exposure history (suicide, sudden death, neither), to assess outcomes and variables of interest among 4,500 Veterans (1,500 respondents per exposure group). Wave 3 involves interviews with a purposive subsample of 32 Waves 2 survey responders who have been exposed to suicide but differ in outcomes. Quantitative analysis is the priority of the study; the qualitative component will contextualize the quantitative findings. Next Steps/ Implementation: This work will direct VA and the field towards an understanding of the most critical outcomes among veterans exposed to suicide, the mechanisms that may lead to deleterious outcomes, and lay a foundation for understanding the effective treatments and supports needed for Veterans who experience a suicide loss, including women and AI/AN Veterans.

背景：自杀的人数远远超过个人的死亡。那些被揭露的人（被定义为知道 自杀死亡的人，患精神疾病、身体障碍、社交障碍的风险更高。 以及致命和非致命的自杀行为。从少数研究中得出的结论， 退伍军人中的这一主题受到不同样本、有限样本量和其他方法学问题的限制。 此外，在这些研究中，女性和少数民族/种族服务人员和退伍军人的数量 太小，无法研究性别和种族之间可能存在的关键差异。 意义：这项研究将提供一个未充分研究的自杀危险因素的基础信息， 自杀风险增加的退伍军人队列-在军事分离后六年内的9/11退伍军人。它 将提供信息，以告知针对自杀丧失亲人人群的自杀后预防策略 9/11事件后的退伍军人以及针对妇女和美国印第安人/阿拉斯加原住民（AI/AN）的退伍军人。 创新和影响：（1）使用VA数据提供最可靠的自杀患病率估计 （2）对脆弱但研究不足的人群进行了过度抽样-妇女和 AI/AN退伍军人;（3）纳入两个比较组，以阐明AI/AN退伍军人的共同和独特贡献。 自杀暴露的健康结果和模式的VA服务利用;和（4）评估的正式 和非正式支持退伍军人接受与自杀相关的心理健康问题， 和VA医疗保健利用数据。 具体目的：（1）评估创伤后应激障碍（PTSD）患病率的差异， 悲伤障碍（PGD），以及有自杀风险的退伍军人的自杀想法、企图和计划 与那些暴露于其他猝死原因的人和未暴露的退伍军人相比。我们还将 评估性别和种族的差异。(2)确定可改变的调节因素， 自杀暴露和负面结果以及自杀之间关联的可修改的调节因素 或猝死暴露和负面结果相对于那些没有暴露。(3)描述治疗 经验，兴趣，报告的自杀企图，以及那些暴露于VA服务利用模式 与暴露于其他突然死亡的退伍军人和未暴露的退伍军人相比，自杀死亡。（四） 通过对有目的的自杀退伍军人样本的访谈，将定量研究结果置于情境中。 访谈将集中在自杀预防的社会生态模型的每个层面上的可改变因素 以更好地了解干预目标。 方法学：这项解释性顺序混合方法研究考察了与自杀相关的结局。 在VA医疗保健中招募的9/11后退伍军人的全国代表性样本中的暴露。我们将收集 三波数据。第一波将使用一个简短的调查来实施全国人口概率抽样， 评估暴露史（自杀，其他猝死，两者都没有）和暴露特征（例如，以来 在11,400名退伍军人受访者中。第2波将调查第1波受访者，按暴露分层 历史（自杀，猝死，两者都没有），以评估4，500名退伍军人的结果和变量 （每个接触组1，500名受访者）。第三波包括对32个波的有目的的子样本的采访 2名曾接触过自杀但结果不同的调查应答者。定量分析是 研究的优先事项;定性部分将结合定量结果。 下一步/实施：这项工作将指导VA和该领域了解最关键的 暴露于自杀的退伍军人的结果，可能导致有害结果的机制， 了解有效的治疗和支持的退伍军人谁经历了一个基础， 自杀损失，包括妇女和AI/AN退伍军人。