Ursano Robert J, Kessler Ronald C, Naifeh James A, Mash Holly Herberman, Fullerton Carol S, Bliese Paul D, Wynn Gary H, Aliaga Pablo A, Wryter Christina, Sampson Nancy A, Kao Tzu-Cheg, Colpe Lisa J, Schoenbaum Michael, Cox Kenneth L, Heeringa Steven G, Stein Murray B
Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
Department of Health Care Policy, Harvard Medical School, 180A Longwood Avenue, Boston, MA 02115.
Mil Med. 2017 Mar;182(3):e1697-e1703. doi: 10.7205/MILMED-D-16-00270.
Improvised explosive devices (IEDs) were a prominent and initially new threat in the Iraq and Afghanistan war which raised concerns and anticipatory fear in and out of theater. This study examined the association of monthly IED rates with risk of soldier suicide attempt among those deployed and nondeployed.
Person-month records for all active duty Regular Army suicide attempters from 2004 through 2009 (n = 9,791) and an equal-probability sample of control person-months (n = 183,826) were identified. Logistic regression analyses examined soldiers' risk of attempting suicide as a function of monthly IED frequency, controlling for sociodemographics, service-related characteristics, rate of deployment/redeployment, and combat deaths and injuries. The association of IED frequency with suicide attempt was examined overall and by time in service and deployment status.
Soldiers' risk of suicide attempt increased with increasing numbers of IEDs. Suicide attempt was 26% more likely for each 1,000 IED increase in monthly frequency (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.22-1.30). The association of IED frequency with suicide attempt was greater for soldiers in their first 2 years of service (OR = 1.30, 95% CI = 1.25-1.36) than for those with 3 or more years of service (OR = 1.18, 95% CI = 1.12-1.24). Among soldiers in their first 2 years of service, the association was constant, regardless of deployment status (χ = 3.89, p = 0.14). Among soldiers with 3 or more years of service, the association was higher for those never deployed (OR = 1.12, 95% CI = 1.01-1.24) and currently deployed (OR = 1.14, 95% CI = 1.05-1.23) than for those previously deployed.
To our knowledge, this is the first study to examine and demonstrate an association between the aggregate frequency of IEDs and risk of suicide attempts among U.S. Army soldiers. This association was observed across deployment status and time in service, and for early-career soldiers in particular. The findings suggest that the threat of new weapons may increase stress burden among soldiers. Targeting risk perception and perceived preparedness, particularly early in a soldier's career, may improve psychological resilience and reduce suicide risk.
简易爆炸装置（IED）在伊拉克和阿富汗战争中是一个突出且最初较为新颖的威胁，在战区内外引发了担忧和预期恐惧。本研究调查了IED月度发生率与已部署和未部署士兵自杀未遂风险之间的关联。
确定了2004年至2009年所有现役正规军自杀未遂者的人月记录（n = 9791）以及同等概率抽样的对照人月记录（n = 183826）。逻辑回归分析将士兵自杀未遂风险作为月度IED频率的函数进行检验，同时控制社会人口统计学、与服役相关的特征、部署/重新部署率以及战斗伤亡情况。总体上以及按服役时间和部署状态考察了IED频率与自杀未遂之间的关联。
士兵自杀未遂风险随IED数量增加而上升。月度频率每增加1000次IED，自杀未遂的可能性增加26%（优势比[OR] = 1.26，95%置信区间[CI] = 1.22 - 1.30）。服役头两年的士兵中，IED频率与自杀未遂之间的关联（OR = 1.30，95% CI = 1.25 - 1.36）大于服役3年或更长时间的士兵（OR = 1.18，95% CI = 1.12 - 1.24）。在服役头两年的士兵中，无论部署状态如何，这种关联都是恒定的（χ = 3.89，p = 0.14）。在服役3年或更长时间的士兵中，从未部署过的士兵（OR = 1.12，95% CI = 1.01 - 1.24）和当前部署的士兵（OR = 1.14，95% CI = 1.05 - 1.23）中这种关联高于曾部署过的士兵。
据我们所知，这是第一项研究并证明美国陆军士兵中IED总频率与自杀未遂风险之间存在关联的研究。这种关联在不同部署状态和服役时间均有观察到，尤其是对于早期职业生涯的士兵。研究结果表明，新武器的威胁可能会增加士兵的压力负担。针对风险认知和感知准备情况，特别是在士兵职业生涯早期，可能会提高心理适应能力并降低自杀风险。
