Fonda Jennifer R, Fredman Lisa, Brogly Susan B, McGlinchey Regina E, Milberg William P, Gradus Jaimie L
Am J Epidemiol. 2017 Jul 15;186(2):220-226. doi: 10.1093/aje/kwx044.
Studies of the association between traumatic brain injury (TBI) and suicide attempt have yielded conflicting results. Furthermore, no studies have examined the possible mediating role of common comorbid psychiatric conditions in this association. This study used Veterans Affairs registry data to evaluate the associations between deployment-related TBI, psychiatric diagnoses, and attempted suicide among 273,591 veterans deployed in support of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn, and who received care from the Department of Veterans Affairs during 2007-2012. We performed Cox proportional hazards regression analyses, adjusting for demographic characteristics. Mediation analyses were conducted to quantify the impact of psychiatric conditions (posttraumatic stress disorder, depression, anxiety, and substance abuse) on this association. The sample was predominantly male (84%); mean age = 28.7 years. Veterans with TBI (16%) were more likely to attempt suicide than those without (0.54% vs. 0.14%): adjusted hazards ratio = 3.76, 95% confidence interval: 3.15, 4.49. This association was attenuated in mediation analyses (adjusted hazards ratio = 1.25, 95% confidence interval: 1.07, 1.46), with 83% of the association of TBI with attempted suicide mediated by co-occurring psychiatric conditions and with posttraumatic stress disorder having the largest impact. These results suggest that veterans with these conditions should be closely monitored for suicidal behavior.
关于创伤性脑损伤（TBI）与自杀未遂之间关联的研究结果相互矛盾。此外，尚无研究探讨常见共病精神疾病在这种关联中可能起到的中介作用。本研究利用退伍军人事务部的登记数据，评估了273591名曾参与持久自由行动、伊拉克自由行动和新黎明行动，并于2007年至2012年期间接受退伍军人事务部医疗服务的退伍军人中，与部署相关的创伤性脑损伤、精神疾病诊断和自杀未遂之间的关联。我们进行了Cox比例风险回归分析，并对人口统计学特征进行了调整。进行中介分析以量化精神疾病（创伤后应激障碍、抑郁症、焦虑症和药物滥用）对这种关联的影响。样本以男性为主（84%）；平均年龄为28.7岁。患有创伤性脑损伤的退伍军人（16%）比未患创伤性脑损伤的退伍军人更有可能自杀未遂（0.54%对0.14%）：调整后的风险比为3.76，95%置信区间：3.15，4.49。在中介分析中，这种关联减弱了（调整后的风险比为1.25，95%置信区间：1.07，1.46），创伤性脑损伤与自杀未遂之间83%的关联由共病精神疾病介导，其中创伤后应激障碍的影响最大。这些结果表明，应对患有这些疾病的退伍军人密切监测其自杀行为。
