Integrating signals of suicide risk from DoD and VHA data to improve upon suicide risk prevention strategies for combat Veterans

摘要 从历史上看，将国防部(DoD)和退伍军人事务部(VA)的数据联系起来的机会 是非常有限的。观察战士手术归来后不久出现的问题 持久自由/伊拉克自由/新黎明行动(OEF/OIF/OND)部署以及 超时和在过渡期间(例如，在部署时间和进入 退伍军人健康管理局[VHA]护理)，预计将增加对自杀风险的理解 发展起来。这项研究中概述的工作将使团队能够合并现有的数据集，即物质使用 和心理伤害战斗研究(Supic)，这是一个超过865,000名陆军现役人员的纵向数据库 (AD)和从OEF/OIF/OND部署返回的国民警卫队/预备役士兵(NG/RS) 和VHA内可用的行政数据，包括国家死亡指数(NDI)数据。自杀及其他 整个SuIPIC队列的死因数据都是可用的，无论他们是否寻求 VHA关怀。如本申请中所述，这个跨学科研究团队的成员建议将 SUPIC队列数据库到VHA和NDI数据，使我们能够检查以下内容：目标1：估计后 按服务组成部分(即AD、NG/RS)分列的部署自杀率和依赖时间的自杀率； 性别、年龄和军龄。目标2：在分离(AD)或复员的苏皮克士兵中 (RS/NG)，开发包含人口统计特征的自杀风险算法， 军事经历(例如，战斗暴露、军事占领)、分离特征和临床 诊断。目标3：在素皮克退伍军人中，比较那些从事VHA服务的人和那些从事VHA服务的人 不。在那些从事VHA服务的人中，检查VHA的时间、频率和类型 所使用的服务与自杀死亡有关。目标4：评估增强退伍军人事务部预测性使用的潜力 通过纳入国防部捕获的自杀风险因素来识别自杀高危退伍军人的建模 数据。使用SUPIC数据库，这是一个以人口为基础的大样本，将能够分析分 群体，如按组成部分、性别和军事经历。此外，与以前的VHA利用率研究不同， 这一努力将使团队能够通过选择队列来前瞻性地确定符合VHA条件的完整人群 通过国防部记录，并对这些士兵进行纵向跟踪，观察VHA的利用情况。由此得出的结论 拟议的努力将提供迄今为止关于员额特点的最全面的经验证据-- 部署队列(即风险因素)与自杀结果的关系。预计调查结果将为政策制定提供依据 具有关键信息的制造商、研究人员和临床医生，以计划旨在减少 近端和远端的消极精神后果，包括自杀死亡。

Abstract Historically, opportunities to link data from the Departments of Defense (DoD) and Veterans Affairs (VA) have been extremely limited. Observing problems that emerge among Soldiers soon after they return from Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) deployments, as well as those that develop overtime and during periods of transition (e.g., between time of deployment and entry into Veterans Health Administration [VHA] care), is expected to increase understanding of how risk for suicide develops. Work outlined in this study will allow the team to merge an existing data set, the Substance Use and Psychological Injury Combat Study (SUPIC), a longitudinal database of over 865,000 Army Active Duty (AD) and National Guard/Reserve Soldiers (NG/RS) returning from OEF/OIF/OND deployments with clinical and administrative data available within the VHA, including National Death Index (NDI) data. Suicide and other cause of death data are available for the entire SUIPIC cohort, regardless of whether or not they have sought VHA care. As outlined in this application, members of this team of interdisciplinary researchers propose linking the SUPIC cohort database to VHA and NDI data, allowing us to examine the following: AIM 1: Estimate post- deployment suicide rates and time dependent suicide hazard rates by service component (i.e., AD, NG/RS), sex, age, and military experience. AIM 2: Among SUPIC Soldiers who have separated (AD) or demobilized (RS/NG) from military service, develop a suicide risk algorithm that incorporates demographic characteristics, military experiences (e.g., combat exposure, military occupation), separation characteristics, and clinical diagnoses. AIM 3: Among SUPIC Veterans, compare those who engaged in VHA services and those that did not. Among those who have engaged in VHA services examine how timing, frequency, and type of VHA services used relate to death by suicide. AIM 4: Evaluate the potential to enhance the VA's use of predictive modeling to identify Veterans at high risk for suicide by incorporating suicide risk factors captured within DoD data. Use of the SUPIC database, which is a large population-based sample, will permit analyses of sub- groups, such as by component, sex, and military experience. Moreover, unlike previous VHA utilization studies, this effort will allow the team to prospectively identify a complete VHA-eligible population by selecting a cohort through DOD records, and tracking these Soldiers longitudinally to observe VHA utilization. Findings from this proposed effort will provide the most comprehensive, empirical evidence to date on characteristics of a post- deployment cohort (i.e., risk factors) in relation to suicide outcomes. Findings are expected to provide policy makers, researchers, and clinicians with critical information to plan for early interventions aimed at reducing proximal and distal negative psychiatric outcomes including death by suicide.