Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX 78229.
Department of Psychology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249.
Mil Med. 2020 Dec 30;185(11-12):e1968-e1976. doi: 10.1093/milmed/usaa201.
Suicide is a significant problem in the U.S. military, with rates surpassing the U.S. general population as of 2008. Although there have been significant advances regarding suicide risk factors among U.S. military service members and veterans, there is little research about risk factors associated with suicide that could be potentially identified in theater. One salient study group consists of service members who receive a psychiatric aeromedical evacuation out of theater. The primary aims of this study were as follows: (1) determine the incidence of suicide-related aeromedical evacuation in deployed service members, (2) identify demographic and military characteristics associated with suicide-related aeromedical evacuation, and (3) evaluate the relationship between suicide-related aeromedical evacuation from a deployed setting and military separation.
This was an archival analysis of U.S. Transportation Command Regulating and Command and Control Evacuation System and Defense Manpower Data Center electronic records of U.S. military service members (N = 7023) who were deployed to Iraq or Afghanistan and received a psychiatric aeromedical evacuation out of theater between 2001 and 2013. χ2 tests of independence and standardized residuals were used to identify cells with observed frequencies and proportions, respectively, that significantly differed from what would be expected by chance. In addition, odds ratios were calculated to provide context about the nature of any significant relationships.
For every 1000 psychiatric aeromedical evacuations that occurred between 2001 and 2013, 34.4 were suicide related. Gender, ethnicity, branch of service, occupation classification, and deployment theater were associated with suicide-related aeromedical evacuation (odds ratios ranged from 1.37 to 3.02). Overall, 53% of all service members who received an aeromedical evacuation for any psychiatric condition had been separated from the military for a variety of reasons (both voluntary and involuntary) upon record review in 2015. Suicide-related aeromedical evacuation was associated with a 37% increased risk of military separation compared to evacuation for another psychiatric condition (P < 0.02).
Findings provide novel information on risk factors associated with suicide-related aeromedical evacuation as well as military separation following a suicide-related aeromedical evacuation. In many cases, the psychiatric aeromedical evacuation of a service member for suicidal ideations and their subsequent separation from active duty is in the best interest of the individual and the military. However, the evacuation and eventual military separation can be costly for the military and the service member. Consequently, the military should focus on indicated prevention interventions for individuals who show sufficient early signs of crisis and functional problems so that specialized interventions can be used in theater to prevent evacuation. Indicated prevention interventions should start with leaders' awareness and mitigation of risk and, when feasible, evidence-based interventions for suicide risk provided by behavioral health (eg, brief cognitive behavioral therapy for suicide). Future research should evaluate the feasibility, safety, and efficacy of delivering suicide-related interventions in theater.
自杀在美国军队中是一个严重的问题，自 2008 年以来，其自杀率已经超过了美国的一般人口。尽管美国军人和退伍军人的自杀风险因素方面已经取得了重大进展，但关于可能在战区中识别出的与自杀相关的风险因素的研究却很少。一个显著的研究群体包括从战区接受精神病学航空医疗后送的军人。本研究的主要目的如下：(1)确定部署军人中与自杀相关的航空医疗后送的发生率；(2)确定与自杀相关的航空医疗后送相关的人口统计学和军事特征；(3)评估从部署环境中与自杀相关的航空医疗后送与军事分离之间的关系。
这是对美国运输司令部调节和指挥与控制撤离系统以及国防人力数据中心的电子记录的档案分析，这些记录包括 2001 年至 2013 年间被部署到伊拉克或阿富汗并从战区接受精神病学航空医疗后送的 7023 名美国军人。χ2 独立性检验和标准化残差用于分别识别观察到的频率和比例显著不同于随机预期的单元格。此外，还计算了优势比，以提供关于任何显著关系性质的背景信息。
在 2001 年至 2013 年间发生的每 1000 次精神病学航空医疗后送中，有 34.4 次与自杀有关。性别、种族、军种、职业分类和部署战区与自杀相关的航空医疗后送有关(优势比范围从 1.37 到 3.02)。总体而言，2015 年记录审查时，所有因各种原因(包括自愿和非自愿)而接受任何精神疾病航空医疗后送的军人中，有 53%已被军队除名。与因其他精神疾病接受航空医疗后送相比，与自杀相关的航空医疗后送与 37%的军人分离风险增加相关(P<0.02)。
研究结果提供了与自杀相关的航空医疗后送以及自杀相关的航空医疗后送后军事分离相关的风险因素的新信息。在许多情况下，为有自杀意念的军人提供精神病学航空医疗后送，并随后将其从现役中分离出来，符合个人和军队的最佳利益。然而，对军队和军人来说，这种后送和最终的军事分离是代价高昂的。因此，军队应该关注有明显危机和功能问题迹象的个人的有针对性的预防干预措施，以便在战区使用专门的干预措施来预防后送。有针对性的预防干预措施应从领导人的意识和风险缓解开始，并在可行的情况下，为自杀风险提供基于行为的健康证据干预措施(例如，简短的认知行为治疗自杀)。未来的研究应评估在战区提供与自杀相关的干预措施的可行性、安全性和疗效。
