Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
Med Care. 2021 Feb 1;59(2 Suppl):S42-S50. doi: 10.1097/MLR.0000000000001425.
To examine sex differences in risk for administratively documented suicide attempt (SA) among US Army soldiers during the Iraq/Afghanistan wars.
Using administrative person-month records of Regular Army enlisted soldiers from 2004 to 2009, we identified 9650 person-months with a first documented SA and an equal-probability control sample (n=153,528 person-months). Person-months were weighted to the population and pooled over time. After examining the association of sex with SA in a logistic regression analysis, predictors were examined separately among women and men.
Women (an estimated 13.7% of the population) accounted for 25.2% of SAs and were more likely than men to attempt suicide after adjusting for sociodemographic, service-related, and mental health diagnosis (MHDx) variables (odds ratio=1.6; 95% confidence interval, 1.5-1.7). Women with increased odds of SA in a given person-month were younger, non-Hispanic White, less educated, in their first term of enlistment, never or previously deployed (vs. currently deployed), and previously received a MHDx. The same variables predicted SA among men. Interactions indicated significant but generally small differences between women and men on 6 of the 8 predictors, the most pronounced being time in service, deployment status, and MHDx. Discrete-time survival models examining risk by time in service demonstrated that patterns for women and men were similar, and that women's initially higher risk diminished as time in service increased.
Predictors of documented SAs are similar for US Army women and men. Differences associated with time in service, deployment status, and MHDx require additional research. Future research should consider stressors that disproportionately affect women.
探讨美国陆军士兵在伊拉克/阿富汗战争期间行政记录自杀未遂（SA）的性别差异。
使用 2004 年至 2009 年现役军人的行政人员月记录，我们确定了 9650 个人月的首次记录 SA 和一个相等概率的对照样本（n=153528 个人月）。个人月份按人口加权并随时间汇总。在 logistic 回归分析中检查性别与 SA 的关联后，分别在女性和男性中检查预测因素。
女性（估计占人口的 13.7%）占 SA 的 25.2%，调整社会人口统计学、与服务相关和心理健康诊断（MHDx）变量后，自杀未遂的可能性高于男性（比值比=1.6；95%置信区间，1.5-1.7）。在给定的个人月中，女性 SA 的可能性增加的是年龄较小、非西班牙裔白人、受教育程度较低、首次入伍、从未或以前部署（与当前部署相比）以及以前接受过 MHDx。相同的变量预测了男性的 SA。交互作用表明，在 8 个预测因素中有 6 个因素在女性和男性之间存在显著但通常较小的差异，最明显的是服务时间、部署状态和 MHDx。检查服务时间风险的离散时间生存模型表明，女性和男性的模式相似，女性最初的高风险随着服务时间的增加而降低。
美国陆军女性和男性的自杀未遂记录预测因素相似。与服务时间、部署状态和 MHDx 相关的差异需要进一步研究。未来的研究应该考虑那些不成比例地影响女性的压力源。
