Conner Kenneth R, Bossarte Robert M, He Hua, Arora Jyoti, Lu Naiji, Tu Xin M, Katz Ira R
US Department of Veterans Affairs (VA) VISN 2 Center of Excellence for Suicide Prevention, USA; University of Rochester Medical Center, USA.
US Department of Veterans Affairs (VA) VISN 2 Center of Excellence for Suicide Prevention, USA; University of Rochester Medical Center, USA.
J Affect Disord. 2014 Sep;166:1-5. doi: 10.1016/j.jad.2014.04.067. Epub 2014 May 5.
Post-traumatic stress disorder (PTSD) confers risk for suicidal ideation and suicide attempts but a link with suicide is not yet established. Prior analyses of users of the Veterans health administration (VHA) Health System suggest that other mental disorders strongly influence the association between PTSD and suicide in this population. We examined the association between PTSD and suicide in VHA users, with a focus on the influence of other mental disorders.
Data were based on linkage of VA National Patient Care Database records and the Centers for Disease Control and Prevention׳s National Death Index, with data from fiscal year 2007-2008. Analyses were based on multivariate logistic regression and structural equation models.
Among users of VHA services studied (N=5,913,648), 0.6% (N=3620) died by suicide, including 423 who had had been diagnosed with PTSD. In unadjusted analysis, PTSD was associated with increased risk for suicide, with odds ratio, OR (95% confidence interval, 95% CI)=1.34 (1.21, 1.48). Similar results were obtained after adjustment for demographic variables and veteran characteristics. After adjustment for multiple other mental disorder diagnoses, PTSD was associated with decreased risk for suicide, OR (95% CI)=0.77 (0.69, 0.86). Major depressive disorder (MDD) had the largest influence on the association between PTSD and suicide.
The analyses were cross-sectional. VHA users were studied, with unclear relevance to other populations.
The findings suggest the importance of identifying and treating comorbid MDD and other mental disorders in VHA users diagnosed with PTSD in suicide prevention efforts.
创伤后应激障碍（PTSD）会增加自杀意念和自杀未遂的风险，但与自杀之间的联系尚未确立。先前对退伍军人健康管理局（VHA）医疗系统用户的分析表明，其他精神障碍会强烈影响该人群中PTSD与自杀之间的关联。我们研究了VHA用户中PTSD与自杀之间的关联，重点关注其他精神障碍的影响。
数据基于VA国家患者护理数据库记录与疾病控制和预防中心的国家死亡指数的关联，数据来自2007 - 2008财年。分析基于多变量逻辑回归和结构方程模型。
在研究的VHA服务用户中（N = 5,913,648），0.6%（N = 3620）死于自杀，其中包括423名被诊断患有PTSD的患者。在未调整的分析中，PTSD与自杀风险增加相关，优势比（OR，95%置信区间，95%CI）= 1.34（1.21，1.48）。在调整人口统计学变量和退伍军人特征后获得了类似的结果。在调整了多种其他精神障碍诊断后，PTSD与自杀风险降低相关，OR（95%CI）= 0.77（0.69，0.86）。重度抑郁症（MDD）对PTSD与自杀之间的关联影响最大。
分析为横断面研究。研究对象为VHA用户，与其他人群的相关性尚不清楚。
研究结果表明，在预防自杀的努力中，识别和治疗被诊断患有PTSD的VHA用户中的共病MDD和其他精神障碍具有重要意义。
