Department of Psychology,Harvard University,Cambridge,MA,02138,USA.
Department of Psychiatry,Center for the Study of Traumatic Stress,Uniformed Services,University of Health Sciences Bethesda,MD,20814,USA.
Psychol Med. 2017 Nov;47(15):2663-2674. doi: 10.1017/S0033291717001179. Epub 2017 May 15.
The suicide rate has increased significantly among US Army soldiers over the past decade. Here we report the first results from a large psychological autopsy study using two control groups designed to reveal risk factors for suicide death among soldiers beyond known sociodemographic factors and the presence of suicide ideation.
Informants were next-of-kin and Army supervisors for: 135 suicide cases, 137 control soldiers propensity-score-matched on known sociodemographic risk factors for suicide and Army history variables, and 118 control soldiers who reported suicide ideation in the past year.
Results revealed that most (79.3%) soldiers who died by suicide have a prior mental disorder; mental disorders in the prior 30-days were especially strong risk factors for suicide death. Approximately half of suicide decedents tell someone that they are considering suicide. Virtually all of the risk factors identified in this study differed between suicide cases and propensity-score-matched controls, but did not significantly differ between suicide cases and suicide ideators. The most striking difference between suicides and ideators was the presence in the former of an internalizing disorder (especially depression) and multi-morbidity (i.e. 3+ disorders) in the past 30 days.
Most soldiers who die by suicide have identifiable mental disorders shortly before their death and tell others about their suicidal thinking, suggesting that there are opportunities for prevention and intervention. However, few risk factors distinguish between suicide ideators and decedents, pointing to an important direction for future research.
在过去的十年中，美国陆军士兵的自杀率显著上升。在这里，我们报告了一项大型心理尸检研究的首批结果，该研究使用了两个对照组，旨在揭示士兵自杀死亡的风险因素，这些因素超出了已知的社会人口因素和自杀意念的存在。
知情人是近亲以及陆军主管：135 例自杀案例、137 例按已知自杀社会人口风险因素和军队历史变量进行倾向评分匹配的对照士兵，以及 118 例报告过去一年有自杀意念的对照士兵。
结果显示，大多数（79.3%）自杀士兵之前都有精神障碍；在过去 30 天内出现精神障碍是自杀死亡的特别强烈的危险因素。大约一半的自杀死者会告诉某人他们正在考虑自杀。实际上，本研究中确定的所有风险因素在自杀案例和倾向评分匹配对照之间均存在差异，但在自杀案例和自杀意念者之间没有显著差异。自杀者和有自杀意念者之间最显著的区别是前者在过去 30 天内存在一种内化障碍（尤其是抑郁症）和多种疾病（即 3 种以上疾病）。
大多数自杀身亡的士兵在死亡前不久都有可识别的精神障碍，并向他人透露自己的自杀想法，这表明有机会进行预防和干预。然而，很少有风险因素可以区分有自杀意念者和死者，这指向了未来研究的一个重要方向。
