Pethrus Carl-Martin, Johansson Kari, Neovius Kristian, Reutfors Johan, Sundström Johan, Neovius Martin
Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Cyclo AB, Stockholm, Sweden.
BMJ Open. 2017 Sep 1;7(9):e014034. doi: 10.1136/bmjopen-2016-014034.
To investigate suicide and mortality risk in deployed military veterans versus non-deployed comparators who had gone through military conscription testing.
Population-based matched cohort study.
Sweden.
Participants were identified from the Military Service Conscription Register and deployment status from the Swedish Military Information Personnel Register. Of 1.9 million conscripts, 21 721 had deployed at some time between 1990 and 2013 (deployed military veterans). Non-deployed comparators were matched to deployed military veterans in two ways: (1) by cognitive ability, psychological assessment, mental health, body mass index, sex, birth-year and conscription-year (carefully matched), with further adjustment for exercise capacity and suicide attempt history; and (2) by sex, birth-year and conscription-year (age- and sex-matched).
Suicide retrieved from the Swedish National Patient and Causes of Death Register until 31 December 2013.
During a median follow-up of 12 years, 39 and 211 deaths by suicide occurred in deployed military veterans (n=21 627) and carefully matched non-deployed comparators (n=107 284), respectively (15 vs 16/100 000 person-years; adjusted HR (aHR) 1.07; 95% CI 0.75 to 1.52; p=0.72) and 329 in age- and sex-matched non-deployed comparators (n=108 140; 25/100 000 person-years; aHR 0.59; 95% CI 0.42 to 0.82; p=0.002). There were 284 and 1444 deaths by suicide or attempted suicides in deployed military veterans and carefully matched non-deployed comparators, respectively (109 vs 112; aHR 0.99; 95% CI 0.88 to 1.13; p=0.93) and 2061 in age- and sex-matched non-deployed comparators (158; aHR 0.69; 95% CI 0.61 to 0.79; p<0.001). The corresponding figures for all-cause mortality for carefully matched non-deployed comparators were 159 and 820 (61 vs 63/100 000 person-years; aHR 0.97; 95% CI 0.82 to 1.15; p=0.71) and 1289 for age- and sex-matched non-deployed comparators (98/100 000 person-years; aHR 0.62; 95% CI 0.52 to 0.73; p<0.001).
Deployed military veterans had similar suicide and mortality risk as non-deployed comparators after accounting for psychological, psychiatric and physical factors. Studies of mental health in deployed veterans need to adjust for more factors than age and sex for comparisons to be meaningful.
调查已部署的退伍军人与经历过征兵测试的未部署对照者的自杀及死亡风险。
基于人群的匹配队列研究。
瑞典。
从兵役登记册中识别参与者，并从瑞典军事信息人员登记册中获取部署状态。在190万应征入伍者中，有21721人在1990年至2013年期间的某个时间进行了部署（已部署的退伍军人）。未部署对照者通过两种方式与已部署的退伍军人进行匹配：（1）通过认知能力、心理评估、心理健康、体重指数、性别、出生年份和征兵年份（精确匹配），并进一步调整运动能力和自杀未遂史；（2）通过性别、出生年份和征兵年份（年龄和性别匹配）。
截至2013年12月31日从瑞典国家患者和死亡原因登记册中检索到的自杀情况。
在中位随访12年期间，已部署的退伍军人（n = 21627）和精确匹配的未部署对照者（n = 107284）中分别有39例和211例自杀死亡（每10万人年分别为15例和16例；调整后风险比（aHR）为1.07；95%置信区间为0.75至1.52；p = 0.72），年龄和性别匹配的未部署对照者（n = 108140）中有329例（每10万人年25例；aHR为0.59；95%置信区间为0.42至0.82；p = 0.002）。已部署的退伍军人和精确匹配的未部署对照者中分别有284例和1444例自杀或自杀未遂死亡（每10万人年分别为109例和112例；aHR为0.99；95%置信区间为0.88至1.13；p = 0.93），年龄和性别匹配的未部署对照者中有2061例（每10万人年158例；aHR为0.69；95%置信区间为0.61至0.79；p < 0.001）。精确匹配的未部署对照者全因死亡率的相应数字分别为159例和820例（每10万人年分别为61例和63例；aHR为0.97；95%置信区间为0.82至1.15；p = 0.71），年龄和性别匹配的未部署对照者为1289例（每10万人年98例；aHR为0.62；95%置信区间为0.52至0.73；p < 0.001）。
在考虑心理、精神和身体因素后，已部署的退伍军人与未部署对照者的自杀及死亡风险相似。为使比较有意义，对已部署退伍军人心理健康的研究需要调整比年龄和性别更多的因素。
