美国陆军新兵中的酒精滥用与共病精神障碍
Alcohol Misuse and Co-Occurring Mental Disorders Among New Soldiers in the U.S. Army.
作者信息
Stein Murray B, Campbell-Sills Laura, Gelernter Joel, He Feng, Heeringa Steven G, Nock Matthew K, Sampson Nancy A, Sun Xiaoying, Jain Sonia, Kessler Ronald C, Ursano Robert J
机构信息
Department of Psychiatry, University of California San Diego, La Jolla, California.
Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California.
出版信息
Alcohol Clin Exp Res. 2017 Jan;41(1):139-148. doi: 10.1111/acer.13269. Epub 2016 Nov 24.
BACKGROUND
Problem drinking that predates enlistment into military service may contribute to the overall burden of alcohol misuse in the Armed Forces; however, evidence bearing on this issue is limited. This study examines prevalence and correlates of alcohol misuse among new U.S. Army soldiers.
METHODS
Cross-sectional survey data were collected from soldiers reporting for basic combat training. The survey retrospectively assessed lifetime alcohol consumption and substance abuse/dependence, enabling estimation of the prevalence of lifetime binge drinking and heavy drinking in a sample of 30,583 soldiers and of probable alcohol use disorder (AUD) among 26,754 soldiers with no/minimal lifetime use of other drugs. Co-occurrence of mental disorders and other adverse outcomes with binge drinking, heavy drinking, and AUD was examined. Discrete-time survival analysis, with person-year the unit of analysis and a logistic link function, was used to estimate associations of AUD with subsequent onset of mental disorders and vice versa.
RESULTS
Weighted prevalence of lifetime binge drinking was 27.2% (SE = 0.4) among males and 18.9% (SE = 0.7) among females; respective estimates for heavy drinking were 13.9% (SE = 0.3) and 9.4% (SE = 0.4). Among soldiers with no/minimal drug use, 9.5% (SE = 0.2) of males and 7.2% (SE = 0.5) of females had lifetime AUD. Relative to no alcohol misuse, binge drinking, heavy drinking, and AUD were associated with increased odds of all mental disorders and other adverse outcomes under consideration (adjusted odds ratios [AORs] = 1.5 to 4.6; ps < 0.001). Prior mental disorders and suicidal ideation were associated with onset of AUD (AORs = 2.3 to 2.8; ps < 0.001), and prior AUD was associated with onset of mental disorders and suicidal ideation (AORs = 2.0 to 3.2, ps < 0.005).
CONCLUSIONS
Strong bidirectional associations between alcohol misuse and mental disorders were observed in a cohort of soldiers beginning Army service. Conjoint recognition of alcohol misuse and mental disorders upon enlistment may provide opportunities for risk mitigation early in a soldier's career.
背景
入伍前就存在的问题饮酒可能会加重军队中酒精滥用的总体负担；然而，关于这一问题的证据有限。本研究调查了美国陆军新兵中酒精滥用的患病率及其相关因素。
方法
收集了报到接受基础战斗训练的士兵的横断面调查数据。该调查回顾性评估了终生饮酒情况以及药物滥用/依赖情况，从而能够估计30583名士兵样本中终生暴饮和重度饮酒的患病率，以及26754名终生很少或未使用其他药物的士兵中可能存在的酒精使用障碍（AUD）患病率。研究了暴饮、重度饮酒和AUD与精神障碍及其他不良后果的共现情况。采用以人年为分析单位并具有逻辑链接函数的离散时间生存分析，来估计AUD与随后精神障碍发病之间的关联，反之亦然。
结果
终生暴饮的加权患病率在男性中为27.2%（标准误=0.4），在女性中为18.9%（标准误=0.7）；重度饮酒的相应估计值分别为13.9%（标准误=0.3）和9.4%（标准误=0.4）。在很少或未使用药物的士兵中，男性有终生AUD的比例为9.5%（标准误=0.2），女性为7.2%（标准误=0.5）。与无酒精滥用相比，暴饮、重度饮酒和AUD与所有所考虑的精神障碍及其他不良后果的发生几率增加相关（调整后的优势比[AORs]=1.5至4.6；p值<0.001）。既往精神障碍和自杀意念与AUD的发病相关（AORs=2.3至2.8；p值<0.001），而既往AUD与精神障碍和自杀意念的发病相关（AORs=2.0至3.2，p值<0.005）。
结论
在开始服兵役的士兵队列中，观察到酒精滥用与精神障碍之间存在强烈的双向关联。入伍时对酒精滥用和精神障碍的联合识别可能为在士兵职业生涯早期减轻风险提供机会。
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