Ursano Robert J, Kessler Ronald C, Naifeh James A, Herberman Mash Holly, Fullerton Carol S, Bliese Paul D, Zaslavsky Alan M, Ng Tsz Hin Hinz, Aliaga Pablo A, Wynn Gary H, Dinh Hieu M, McCarroll James E, Sampson Nancy A, Kao Tzu-Cheg, Schoenbaum Michael, Heeringa Steven G, Stein Murray B
Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
JAMA Psychiatry. 2017 Sep 1;74(9):924-931. doi: 10.1001/jamapsychiatry.2017.1925.
Mental health of soldiers is adversely affected by the death and injury of other unit members, but whether risk of suicide attempt is influenced by previous suicide attempts in a soldier's unit is unknown.
To examine whether a soldier's risk of suicide attempt is influenced by previous suicide attempts in that soldier's unit.
DESIGN, SETTING, AND PARTICIPANTS: Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers (STARRS), this study identified person-month records for all active-duty, regular US Army, enlisted soldiers who attempted suicide from January 1, 2004, through December 31, 2009 (n = 9650), and an equal-probability sample of control person-months (n = 153 528). Data analysis was performed from August 8, 2016, to April 10, 2017.
Logistic regression analyses examined the number of past-year suicide attempts in a soldier's unit as a predictor of subsequent suicide attempt, controlling for sociodemographic features, service-related characteristics, prior mental health diagnosis, and other unit variables, including suicide-, combat-, and unintentional injury-related unit deaths. The study also examined whether the influence of previous unit suicide attempts varied by military occupational specialty (MOS) and unit size.
Of the final analytic sample of 9512 enlisted soldiers who attempted suicide and 151 526 control person-months, most were male (86.4%), 29 years or younger (68.4%), younger than 21 years when entering the army (62.2%), white (59.8%), high school educated (76.6%), and currently married (54.8%). In adjusted models, soldiers were more likely to attempt suicide if 1 or more suicide attempts occurred in their unit during the past year (odds ratios [ORs], 1.4-2.3; P < .001), with odds increasing as the number of unit attempts increased. The odds of suicide attempt among soldiers in a unit with 5 or more past-year attempts was more than twice that of soldiers in a unit with no previous attempts (OR, 2.3; 95% CI, 2.1-2.6). The association of previous unit suicide attempts with subsequent risk was significant whether soldiers had a combat arms MOS or other MOS (ORs, 1.4-2.3; P < .001) and regardless of unit size, with the highest risk among those in smaller units (1-40 soldiers) (ORs, 2.1-5.9; P < .001). The population-attributable risk proportion for 1 or more unit suicide attempts in the past year indicated that, if this risk could be reduced to no unit attempts, 18.2% of attempts would not occur.
Risk of suicide attempt among soldiers increased as the number of past-year suicide attempts within their unit increased for combat arms and other MOSs and for units of any size but particularly for smaller units. Units with a history of suicide attempts may be important targets for preventive interventions.
部队其他成员的伤亡会对士兵的心理健康产生不利影响，但士兵所在部队之前的自杀未遂事件是否会影响其自杀未遂风险尚不清楚。
研究士兵所在部队之前的自杀未遂事件是否会影响该士兵的自杀未遂风险。
设计、背景和参与者：本研究利用陆军研究以评估军人风险与恢复力（STARRS）的行政数据，确定了2004年1月1日至2009年12月31日期间所有自杀未遂的美国陆军现役正规入伍士兵的人月记录（n = 9650），以及一个等概率抽样的对照人月样本（n = 153528）。数据分析于2016年8月8日至2017年4月10日进行。
逻辑回归分析将士兵所在部队过去一年的自杀未遂次数作为后续自杀未遂的预测因素，同时控制社会人口学特征、与服役相关的特征、先前的心理健康诊断以及其他部队变量，包括与自杀、战斗和非故意伤害相关的部队死亡人数。该研究还考察了先前部队自杀未遂的影响是否因军事职业专长（MOS）和部队规模而异。
在最终分析样本中，9512名自杀未遂的入伍士兵和151526个对照人月中，大多数为男性（86.4%），年龄在29岁及以下（68.4%），入伍时年龄小于21岁（62.2%），白人（59.8%），受过高中教育（76.6%），目前已婚（54.8%）。在调整模型中，如果过去一年其所在部队发生1次或更多次自杀未遂事件，士兵自杀未遂的可能性更大（优势比[OR]，1.4 - 2.3；P <.001），且随着部队自杀未遂次数的增加，优势比也增加。过去一年有≥5次自杀未遂事件的部队中的士兵自杀未遂的几率是之前无自杀未遂事件部队中士兵的两倍多（OR，2.3；95%置信区间，2.1 - 2.6）。无论士兵是战斗兵种MOS还是其他MOS，先前部队自杀未遂事件与后续风险之间的关联均显著（OR，1.4 - 2.3；P <.001），且与部队规模无关，较小部队（1 - 40名士兵）中的士兵风险最高（OR，2.1 - 5.9；P <.001）。过去一年有≥1次部队自杀未遂事件的人群归因风险比例表明，如果将这种风险降低至部队无自杀未遂事件，18.2%的自杀未遂事件将不会发生。
对于战斗兵种和其他MOS以及任何规模的部队，尤其是较小部队，士兵的自杀未遂风险随着其所在部队过去一年自杀未遂次数的增加而增加。有自杀未遂历史的部队可能是预防性干预的重要目标。
