Modifiable Risk and Protective Factors for Suicidal Behaviors in the US Army

描述（由申请人提供）：本申请是由四个机构的跨学科团队根据RFA-MH-09-140提交的：健康科学军服大学（USUHS），哈佛医学院（HMS），密歇根大学（UM）和哥伦比亚大学（CU），该团队在军事心理健康（USUHS），一般人群精神流行病学（HMS），大规模流行病学数据收集（UM）和自杀行为的神经生物学临床研究（CU）方面拥有无与伦比的专业知识。我们提出了一项多阶段流行病学研究，考虑了自杀行为和次要后果的各种心理社会和神经生物学风险和保护因素，以便为实施军队自杀预防干预措施提供循证建议。将开发陆军自杀事件报告（ASER）系统的一个丰富版本，以结合来自国防部医疗死亡率登记（MMR）和陆军总伤害和健康结果数据库（TAIHOD）的信息来定义主要结果。我们的研究设计将包括回顾性病例对照部分，用于快速有效的假设检验，以及前瞻性调查部分，用于预测随后的自杀行为和次要结果（DSM-IV障碍的发病、持续、恶化、自杀意念、自杀计划）。我们还将使用正在进行的部署前和部署后健康重新评估计划（PDHRP）调查的数据作为次要结果。这项病例对照调查将在心理解剖框架下研究非致命企图的士兵和自杀士兵的亲属。将从仔细匹配的对照中收集平行数据。将收集血液样本，在非致命企图者及其对照的情况下，将收集唾液样本，以便研究神经生物学风险和保护因素。调查部分将包括陆军所有服役阶段的现役人员。调查报告将与后续的ASER记录和PDHRP报告联系起来，以研究预测因素与自杀行为和次要结果的潜在关联。一些创新的测量、设计和分析特征将被用于增加发现有效干预可能性的机会。

DESCRIPTION (provided by applicant): This application is submitted in response to RFA-MH-09-140 by an interdisciplinary team from four institutions: the Uniformed Services University of the Health Sciences (USUHS), Harvard Medical School (HMS), the University of Michigan (UM), and Columbia University (CU), The team has unparalleled expertise in research on military mental health (USUHS), general population psychiatric epidemiology (HMS), large-scale epidemiological data collection (UM), and neurobiological-clinical research on suicidal behaviors (CU). We propose a multi-phase epidemiological study that considers diverse psychosocial and neurobiological risk and protective factors for suicidal behaviors and secondary outcomes in order to make evidence-based recommendations for implementation of Army suicide prevention interventions. An enriched version of the Army Suicide Event Report (ASER) system will be developed to define the primary outcomes incorporating information from the DoD Medical Mortality Registry (MMR) and Total Army Injury and Health Outcomes Database (TAIHOD). Our study design will include both a retrospective case-control component for quick efficient hypothesis testing and a prospective survey component to predict subsequent suicidal behaviors and secondary outcomes (onset, persistence, worsening of DSM-IV disorders, suicide ideation, suicide plans). We will also use data from the ongoing Pre- and Post-Deployment Health Reassessment Program (PDHRP) surveys as secondary outcomes. The case-control survey will study soldiers who made nonfatal attempts and relatives of soldiers who committed suicide in a psychological autopsy framework. Parallel data will be collected from carefully matched controls. Blood samples and, in the case of nonfatal attempters and their controls, saliva samples will be collected to allow neurobiological risk and protective factors to be studied. The survey component will include active duty personnel across all phases of Army service. Survey reports will be link to subsequent ASER records and PDHRP reports to study prospective associations of predictors with suicidal behaviors and secondary outcomes. A number of innovative measurement, design and analysis features will be used to increase chances of discovering effective intervention possibilities. RELEVANCE: The problem of Army suicide is one of great importance because an effective military force requires its members to be not only physically healthy but also mentally healthy. The relevance of a current study of Army suicide is heightened by the alarming rise in the suicide rate of US Army personnel over the past five years. The research proposed here has the potential to be of great value in helping the Army select optimally effective interventions to address this problem.