Katz Ira R, Dent Kallisse R, Morley Sybil W, Hein Tyler C, Hoff Rani A, McCarthy John F
VA Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC 20420, United States.
VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI 48109, United States.
Psychiatry Res. 2020 Feb 3;285:112841. doi: 10.1016/j.psychres.2020.112841.
Deaths of despair, a composite outcome including suicide and drug- and alcohol-related deaths, have been increasing, especially in subpopulations and geographic areas sensitive to economic and social hardships. The Veterans Health Administration (VHA) has begun evaluating the utility of this concept to guide planning and evaluations of clinical and preventive services for Veterans. In this study, mortality rates for middle-aged American men for 2013 to 2017 were from CDC WONDER, and rates for all Veterans, those using VHA healthcare services (VHA-utilizers), and other (non-VHA) Veterans were derived from National Death Index data. Findings demonstrated that rates for the composite were higher in VHA-utilizers and lower in non-VHA Veterans than middle-aged American men, consistent with use of VHA services by Veterans with the greatest needs. State rates in Veteran men were significantly and positively correlated with state rates for American men, and both were correlated with other characteristics of the social environment. The lack of correlation between rates for suicide and drug-related deaths indicates that deaths of despair cannot be modeled by assuming parallel paths from reactions to community-based stressors to the component outcomes; models should allow for an impact of community characteristics on partitioning between outcomes.
绝望导致的死亡是一个综合结果，包括自杀以及与毒品和酒精相关的死亡，且一直在增加，尤其是在对经济和社会困境敏感的亚人群体和地理区域。退伍军人健康管理局（VHA）已开始评估这一概念在指导退伍军人临床和预防服务规划及评估方面的效用。在本研究中，2013年至2017年美国中年男性的死亡率来自疾病控制与预防中心的WONDER数据库，所有退伍军人、使用VHA医疗服务的退伍军人（VHA使用者）以及其他（非VHA）退伍军人的死亡率则来自国家死亡指数数据。研究结果表明，VHA使用者中综合死亡率较高，非VHA退伍军人中的综合死亡率低于美国中年男性，这与需求最大的退伍军人使用VHA服务的情况一致。退伍军人男性的州死亡率与美国男性的州死亡率显著正相关，且两者均与社会环境的其他特征相关。自杀率与毒品相关死亡率之间缺乏相关性，这表明绝望导致的死亡不能通过假设从对基于社区的压力源的反应到各个组成结果的平行路径来建模；模型应考虑社区特征对结果划分的影响。
