Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Center for Complicated Grief, Columbia School of Social Work, Columbia University, New York, New York.
Depress Anxiety. 2020 Jan;37(1):45-53. doi: 10.1002/da.22971. Epub 2019 Nov 25.
BACKGROUND/OBJECTIVES: Bereavement is associated with increases in prevalence of mental health conditions and in healthcare utilization. Due to younger age and bereavement by sudden and violent deaths, military widows may be vulnerable to poor outcomes. No systematic research has examined these effects.
Using outpatient medical records from wives of active-duty military service members (SMs), we compared the prevalence of mental health conditions and mental healthcare visits among case widows (n = 1,375) to matched (on age, baseline healthcare utilization, SM deployment, and rank) nonbereaved control military wives (n = 1,375), from 1 year prior (Yr-1) to 2 years following (Yr+1 and Yr+2) SM death. Prevalence risk ratios and confidence intervals were compared to determine prevalence rates of mental health conditions and outpatient mental healthcare visits over time.
The prevalence of any mental health condition, as well as a distinct loss- and stress-related mental health conditions, significantly increased from Yr-1 to Yr+1 and Yr+2 for cases as did mental healthcare utilization. Widows with persistent disorders (from Yr+1 to Yr+2) exhibited more mental conditions and mental healthcare utilization than widows whose conditions remitted.
Bereavement among military widows was associated with a two- to fivefold increase in the prevalence of depression, posttraumatic stress disorder, and adjustment disorder postdeath, as well as an increase in mental healthcare utilization. An increase in the prevalence of loss- and stress-related conditions beyond 1 year after death indicates persistent loss-related morbidity. Findings indicate the need for access to healthcare services that can properly identify and treat these loss-related conditions.
背景/目的：丧偶与精神健康状况的患病率增加和医疗保健利用增加有关。由于年龄较小以及因突然和暴力死亡而丧偶，军属遗孀可能面临不良后果。没有系统的研究检查过这些影响。
使用现役军人配偶（SM）的门诊医疗记录，我们将丧偶（n=1375）病例的配偶与匹配（年龄、基线医疗保健利用、SM 部署和级别）的未丧偶对照组军人妻子（n=1375）进行比较，比较了从 SM 死亡前 1 年（Yr-1）到死亡后 2 年（Yr+1 和 Yr+2）期间心理健康状况和精神保健就诊的患病率。通过比较风险比和置信区间来确定精神健康状况和门诊精神保健就诊的患病率随时间的变化。
病例的任何精神健康状况的患病率，以及特定的丧失和应激相关的精神健康状况的患病率，从 Yr-1 到 Yr+1 和 Yr+2 显著增加，同时精神保健利用率也增加了。从 Yr+1 到 Yr+2 持续存在障碍（从 Yr+1 到 Yr+2）的寡妇比病情缓解的寡妇表现出更多的精神状况和精神保健利用。
在军人遗孀中，死亡后抑郁症、创伤后应激障碍和适应障碍的患病率增加了两到五倍，精神保健利用率也增加了。在死亡后 1 年，丧失和应激相关疾病的患病率增加表明持续存在与丧失相关的发病率。这些发现表明需要获得可以正确识别和治疗这些丧失相关疾病的医疗保健服务。
