Risk and Resilience Factors related to Suicidal Ideation during Transition from Military to Civilian Life: Secondary Analyses of the TVMI Cohort Study

从军事生活过渡到平民生活期间与自杀意念相关的风险和弹性因素：TVMI 队列研究的二次分析

• 批准号: 10237121
• 负责人: Dawne Suzanne Vogt-Ryan
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10237121
• 关键词: Attention; Caring; Clinical; Cohort Studies; Cross-Sectional Studies; Data; Feeling suicidal; Female; Growth; Health; Individual; Interruption; Intervention; Investigation; Knowledge; Life; Linear Regressions; Literature; Logistic Regressions; Machine Learning; Measures; Methodology; Military Personnel; Modeling; Nature; Outcome; Personal Satisfaction; Policy Maker; Process; Recommendation; Research; Research Design; Risk; Risk Assessment; Risk Factors; Sampling; Services; Subgroup; Suicide; Suicide prevention; Time; Veterans; Vocation; empowerment; experience; follow up assessment; high risk; innovation; insight; longitudinal dataset; longitudinal design; machine learning method; military service; military veteran; population based; prevent; resilience factor; retention rate; rural area; secondary analysis; social; suicidal; suicidal risk

Background: The Veterans Metrics Initiative (TVMI) Study is the first study to provide a comprehensive examination of military veterans' experiences as they transition from military service. While suicidality was not a primary focus, veterans were asked about experience of suicidal thoughts, as well as life circumstances that may contribute to suicidal thoughts, at each of six timepoints of this three-year study. The current study proposes to leverage these data to examine several important questions pertaining to veterans' suicidal thoughts during transition. Results can inform the identification of veterans at greatest risk for suicidal thoughts during transition and inform interventions aimed at interrupting trajectories that increase risk for suicide. Significance/Impact: This study will provide critical insight into how veterans' experiences of suicidal thoughts change throughout the military to civilian transition, what factors are associated with increases and decreases in suicidal thoughts during transition, and which veterans are most vulnerable to suicidal thoughts following transition. This study is responsive to HSR&D's request for research on veterans' suicidality following transition from military service, as well as key priorities outlined in both VA's National Roadmap to Empower Veterans and End Suicide and the National Strategy for Preventing Veteran Suicide. Innovativeness: The proposed study is innovative in several ways. First, it represents the first in-depth investigation of veterans' suicidal thoughts during their transition from military service. Second, its longitudinal design provides a unique opportunity to isolate factors that lead to changes in suicidal thoughts over time. Third, it offers a much more comprehensive assessment of risk and resilience factors for suicidal thoughts than prior research, drawing from measures of a wide variety of vocational, financial, health, and social experiences that may contribute to suicidality. Fourth, its population-based nature allows for attention to the experiences of veterans who are not adequately represented in prior research, including both non-VA users and veterans from all service branches. Fifth, the sample is large enough to support the type of sophisticated analyses needed to adequately characterize the complexity underlying veterans' suicidal thoughts, as well as separate analyses of smaller subgroups (e.g., female veterans). Specific Aims: Aim 1 is to identify factors present at separation that are associated with veterans' suicidal thoughts within the first year after separation. Aim 2 is to identify post- separation vocational, financial, health, and social experiences that are associated with increase or decreases in suicidal thoughts during transition, either independently or in combination with separation factors. Aim 3 is to identify differences in risk for suicidal thoughts during transition for three high-risk veteran subgroups - female veterans, non-users of VA care, and veterans who live in rural locations, as well as to examine unique risk and resilience factors for suicidal thoughts among each of these groups. Methodology: Over 9500 Veterans participated in a first assessment within approximately three months following separation. Five follow-up assessments were implemented at six-month intervals thereafter, with retention rates ranging from 63% to 77% across timepoints. Analyses will include machine learning, growth curve modeling, and linear and logistic regression. Next Steps/Implementation: Study findings and implementation recommendations will be shared with VA policymakers and clinical leaders following completion of the study.

背景：退伍军人保护倡议（TVMI）研究是第一个提供 全面审查退伍军人的经验，因为他们从军事过渡 的服务.虽然自杀不是一个主要的焦点，退伍军人被问及的经验， 自杀念头，以及可能导致自杀念头的生活环境， 在这三年研究的六个时间点。目前的研究建议利用这些数据， 研究几个重要的问题，有关退伍军人的自杀想法在过渡期间。 结果可以告知退伍军人在最大风险的自杀想法的识别， 过渡和知情干预，旨在中断增加自杀风险的轨迹。 意义/影响：这项研究将提供关键的洞察如何退伍军人的经验， 自杀念头在军转民过程中发生变化，有哪些因素 与过渡期间自杀想法的增加和减少有关， 退伍军人在过渡期最容易产生自杀念头。这项研究是响应 HSR&D要求研究退伍军人从军事过渡后的自杀行为， 服务，以及VA的国家授权退伍军人路线图中概述的关键优先事项 结束自杀和防止退伍军人自杀的国家战略。 创新性：拟议的研究在几个方面具有创新性。首先，它代表了第一个 深入调查退伍军人在服兵役过渡期间的自杀念头。 其次，其纵向设计提供了一个独特的机会，可以隔离导致 随着时间的推移自杀想法的变化。第三，它提供了一个更全面的评估 的风险和弹性因素自杀的想法比以前的研究，从措施， 各种各样的职业，财务，健康和社会经验，可能有助于 自杀倾向第四，其以人口为基础的性质使人们能够注意到 在先前的研究中没有充分代表的退伍军人，包括非VA用户 以及各军种的退伍军人第五，样本足够大，可以支持 需要进行复杂的分析，以充分描述退伍军人的复杂性。 自杀想法，以及较小亚组的单独分析（例如，女性退伍军人）。 具体目标：目标1是确定分离时存在的与下列因素相关的因素： 退伍军人在分离后第一年内的自杀念头。目标2是确定后- 职业，财务，健康和社会经验，与增加 或在过渡期间自杀想法的减少，无论是独立的还是与 分离因素。目的3是确定在过渡期自杀想法的风险差异 对于三个高风险退伍军人亚组-女性退伍军人，非VA护理用户和退伍军人 生活在农村地区的人，以及研究自杀的独特风险和弹性因素 每个群体的想法。 方法：超过9500名退伍军人参加了第一次评估，在大约三个月内， 分离后的几个月。在6个月时进行了5次后续评估 之后的间隔，各时间点的保留率范围为63%至77%。分析 将包括机器学习，增长曲线建模，线性和逻辑回归。 后续步骤/实施：研究结果和实施建议将 研究完成后，与VA决策者和临床负责人共享。

项目成果

The transition to civilian life: Impact of comorbid PTSD, chronic pain, and sleep disturbance on veterans' social functioning and suicidal ideation.

向平民生活的过渡：共病创伤后应激障碍、慢性疼痛和睡眠障碍对退伍军人社会功能和自杀意念的影响。

• DOI: 10.1037/tra0001271
• 发表时间: 2023
• 期刊: Psychological trauma : theory, research, practice and policy
• 作者: Shor,Rachel;Borowski,Shelby;Zelkowitz,RachelL;Pineles,SuzanneL;Copeland,LaurelA;Finley,ErinP;Perkins,DanielF;Vogt,Dawne
• 通讯作者: Vogt,Dawne

Contribution of veterans' initial post-separation vocational, financial, and social experiences to their suicidal ideation trajectories following military service.

• DOI: 10.1111/sltb.12955
• 发表时间: 2023-06
• 期刊: SUICIDE AND LIFE-THREATENING BEHAVIOR
• 影响因子: 3.2
• 作者: Hoffmire, Claire A.;Borowski, Shelby;Vogt, Dawne
• 通讯作者: Vogt, Dawne