Gradus Jaimie L, Leatherman Sarah, Curreri Andrew, Myers Lisa G, Ferguson Ryan, Miller Matthew
National Center for PTSD, VA Boston Healthcare System, 150S. Huntington Ave, 116B-3, Boston, MA 02130, United States; Department of Psychiatry, School of Medicine, Boston University, 715 Albany St., Boston, MA 02118, United States; Department of Epidemiology, School of Public Health, Boston University, 715 Albany St., Boston, MA 02118, United States.
Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, 150S. Huntington Ave., 116B-3, Boston, MA 02130, United States.
Drug Alcohol Depend. 2017 Feb 1;171:66-69. doi: 10.1016/j.drugalcdep.2016.11.012. Epub 2016 Nov 21.
Epidemiologic studies have reported substance abuse and posttraumatic stress disorder (PTSD) diagnoses as risk factors for suicide among Veterans Health Administration (VHA) patients. Research on risk factors for suicide may not generalize to our understanding of non-fatal intentional self-harm (ISH), given the evidence that these outcomes have unique risk factors. The aims of this study were to examine (1) gender-stratified rates of non-fatal ISH in VHA patients with alcohol abuse/dependence, drug abuse/dependence, and PTSD and (2) gender-stratified interaction between alcohol abuse and dependence and drug abuse and dependence and PTSD in predicting non-fatal ISH.
Participants include all VHA care users who received a PTSD diagnosis in Massachusetts from 2000 to 2008 (n=16,004) and an age- and gender-matched comparison group (n=52,502). Data were obtained from the VHA administrative registries.
We found evidence of stronger interactions between substance abuse diagnoses and PTSD in predicting non-fatal ISH for females than for males. The interaction contrast (IC) for alcohol abuse and dependence and PTSD in predicting non-fatal ISH among female VHA patients was 62.35/100,000 person-years; for male VHA patients the comparable IC was 21.49/100,000 person-years. For female VHA patients the IC for drug abuse and dependence and PTSD predicting ISH was 256.33/100,000 person-years; no interaction was observed for male VHA patients.
This study contributes to the scant literature on gender differences in substance abuse and PTSD among VHA patients. The findings highlight comorbid diagnoses as particularly important risk factors for non-fatal ISH among female VHA patients.
流行病学研究报告称，药物滥用和创伤后应激障碍（PTSD）诊断是退伍军人健康管理局（VHA）患者自杀的风险因素。鉴于有证据表明这些结果有独特的风险因素，关于自杀风险因素的研究可能无法推广到我们对非致命性故意自伤（ISH）的理解。本研究的目的是检查（1）患有酒精滥用/依赖、药物滥用/依赖和PTSD的VHA患者中按性别分层的非致命性ISH发生率，以及（2）在预测非致命性ISH方面，酒精滥用与依赖、药物滥用与依赖以及PTSD之间按性别分层的相互作用。
参与者包括2000年至2008年在马萨诸塞州接受PTSD诊断的所有VHA护理使用者（n = 16,004）以及年龄和性别匹配的对照组（n = 52,502）。数据来自VHA行政登记处。
我们发现，在预测女性非致命性ISH方面，药物滥用诊断与PTSD之间的相互作用比男性更强。女性VHA患者中，酒精滥用与依赖和PTSD在预测非致命性ISH方面的相互作用对比（IC）为62.35/100,000人年；男性VHA患者的可比IC为21.49/100,000人年。女性VHA患者中，药物滥用与依赖和PTSD预测ISH的IC为256.33/100,000人年；男性VHA患者未观察到相互作用。
本研究为关于VHA患者药物滥用和PTSD性别差异的稀少文献做出了贡献。研究结果突出了共病诊断是女性VHA患者非致命性ISH的特别重要的风险因素。
