与美国陆军士兵在阿富汗部署期间自杀意念相关的因素。
Factors Associated With Suicide Ideation in US Army Soldiers During Deployment in Afghanistan.
机构信息
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
出版信息
JAMA Netw Open. 2020 Jan 3;3(1):e1919935. doi: 10.1001/jamanetworkopen.2019.19935.
IMPORTANCE
Understanding suicide ideation (SI) during combat deployment can inform prevention and treatment during and after deployment.
OBJECTIVE
To examine associations of sociodemographic characteristics, lifetime and past-year stressors, and mental disorders with 30-day SI among a representative sample of US Army soldiers deployed in Afghanistan.
DESIGN, SETTING, AND PARTICIPANTS: In this survey study, soldiers deployed to Afghanistan completed self-administered questionnaires in July 2012. The sample was weighted to represent all 87 032 soldiers serving in Afghanistan. Prevalence of lifetime, past-year, and 30-day SI and mental disorders was determined. Logistic regression analyses examined risk factors associated with SI. Data analyses for this study were conducted between August 2018 and August 2019.
MAIN OUTCOMES AND MEASURES
Suicide ideation, lifetime and 12-month stressors, and mental disorders were assessed with questionnaires. Administrative records identified sociodemographic characteristics and suicide attempts.
RESULTS
A total of 3957 soldiers (3473 [weighted 87.5%] male; 2135 [weighted 52.6%] aged ≤29 years) completed self-administered questionnaires during their deployment in Afghanistan. Lifetime, past-year, and 30-day SI prevalence estimates were 11.7%, 3.0%, and 1.9%, respectively. Among soldiers with SI, 44.2% had major depressive disorder (MDD) and 19.3% had posttraumatic stress disorder in the past 30-day period. A series of analyses of the 23 grouped variables potentially associated with SI resulted in a final model of sex; race/ethnicity; lifetime noncombat trauma; past 12-month relationship problems, legal problems, and death or illness of a friend or family member; and MDD. In this final multivariable model, white race/ethnicity (odds ratio [OR], 3.1 [95% CI, 1.8-5.1]), lifetime noncombat trauma (OR, 2.1 [95% CI, 1.1-4.0]), and MDD (past 30 days: OR, 31.8 [95% CI, 15.0-67.7]; before past 30 days: OR, 4.9 [95% CI, 2.5-9.6]) were associated with SI. Among the 85 soldiers with past 30-day SI, from survey administration through 12 months after returning from deployment, 6% (5 participants) had a documented suicide attempt vs 0.14% (6 participants) of the 3872 soldiers without SI.
CONCLUSIONS AND RELEVANCE
This study suggests that major depressive disorder and noncombat trauma are important factors in identifying SI risk during combat deployment.
重要性
了解战斗部署期间的自杀意念（SI）可以为部署期间和之后的预防和治疗提供信息。
目的
研究社会人口统计学特征、终身和过去一年的压力源以及精神障碍与美国陆军驻阿富汗士兵代表性样本中 30 天 SI 的关联。
设计、地点和参与者：在这项调查研究中，部署到阿富汗的士兵于 2012 年 7 月完成了自我管理的问卷。该样本经过加权处理，以代表所有在阿富汗服役的 87032 名士兵。确定了终身、过去一年和 30 天 SI 和精神障碍的患病率。逻辑回归分析检查了与 SI 相关的风险因素。本研究的数据分析于 2018 年 8 月至 2019 年 8 月之间进行。
主要结果和措施
使用问卷评估自杀意念、终身和 12 个月的压力源和精神障碍。行政记录确定了社会人口统计学特征和自杀企图。
结果
共有 3957 名士兵（3473 名[加权 87.5%]男性；2135 名[加权 52.6%]年龄≤29 岁）在阿富汗部署期间完成了自我管理的问卷。终身、过去一年和 30 天 SI 的患病率估计分别为 11.7%、3.0%和 1.9%。在有 SI 的士兵中，44.2%有重度抑郁症（MDD），19.3%在过去 30 天内患有创伤后应激障碍。对可能与 SI 相关的 23 组变量的一系列分析得出了一个最终的多变量模型，包括性别；种族/民族；终身非战斗创伤；过去 12 个月的关系问题、法律问题以及朋友或家人的死亡或患病；和 MDD。在这个最终的多变量模型中，白人种族/民族（优势比[OR]，3.1[95%CI，1.8-5.1]）、终身非战斗创伤（OR，2.1[95%CI，1.1-4.0]）和 MDD（过去 30 天：OR，31.8[95%CI，15.0-67.7]；过去 30 天之前：OR，4.9[95%CI，2.5-9.6]）与 SI 相关。在过去 30 天内有 SI 的 85 名士兵中，从问卷调查开始到部署后 12 个月，有 6%（5 名参与者）有记录的自杀企图，而在没有 SI 的 3872 名士兵中，有 0.14%（6 名参与者）有自杀企图。
结论和相关性
这项研究表明，重度抑郁症和非战斗创伤是识别战斗部署期间 SI 风险的重要因素。
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