Fairman Kathleen A, Buckley Kelsey
Midwestern University College of Pharmacy, Department of Pharmacy Practice, Glendale, AZ 85308, USA.
Mil Med. 2022 Mar 28;187(3-4):453-463. doi: 10.1093/milmed/usab249.
Predictors of deaths of despair, including substance use disorder, psychological distress, and suicidality, are known to be elevated among young adults and recent military veterans. Limited information is available to distinguish age effects from service-era effects. We assessed these effects on indicators of potential for deaths of despair in a large national sample of U.S. adults aged ≥19 years.
The study was a retrospective, cross-sectional analysis of publicly available data for 2015-2019 from 201,846 respondents to the National Survey on Drug Use and Health (NSDUH), which measures psychological symptoms and substance use behaviors using standardized scales and diagnostic definitions. Indicators of potential for a death of despair included liver cirrhosis, past-year serious suicidal ideation, serious psychological distress per the Kessler-6 scale, and active substance use disorder (e.g., binge drinking on ≥5 occasions in the past month, nonmedical use of prescribed controlled substances, and illicit drug use). Bivariate, age-stratified bivariate, and multivariate logistic regression analyses were performed using statistical software and tests appropriate for the NSDUH complex sampling design. Covariates included demographic characteristics, chronic conditions, and religious service attendance.
Indicators were strongly and consistently age-associated, with ≥1 indicator experienced by 45.5% of respondents aged 19-25 years and 10.7% of those aged ≥65 years (P < .01). After age stratification, service-era effects were modest and occurred only among adults aged ≥35 years. The largest service-associated increase was among adults aged 35-49 years; service beginning or after 1975 was associated (P < .01), with increased prevalence of ≥1 indicator (30.2%-34.2% for veterans and 25.2% for nonveterans) or ≥2 indicators (6.4%-8.2% for veterans and 5.4% for nonveterans). Covariate-adjusted results were similar, with adjusted probabilities of ≥1 indicator declining steadily with increasing age: among those 19-34 years, 39.9% of nonveterans and 42.2% of Persian Gulf/Afghanistan veterans; among those aged ≥65 years, 10.3% of nonveterans, 9.2% of World War II/Korea veterans, and 14.4% of Vietnam veterans.
After accounting for age, military service-era effects on potential for a death of despair were modest but discernible. Because underlying causes of deaths of despair may vary by service era (e.g., hostility to Vietnam service experienced by older adults versus environmental exposures in the Persian Gulf and Afghanistan), providers treating veterans of different ages should be sensitive to era-related effects. Findings suggest the importance of querying for symptoms of mental distress and actively engaging affected individuals, veteran or nonveteran, in appropriate treatment to prevent deaths of despair.
已知绝望死亡的预测因素，包括物质使用障碍、心理困扰和自杀倾向，在年轻人和近期退伍军人中有所增加。区分年龄效应和服役时期效应的信息有限。我们在美国≥19岁成年人的大型全国样本中评估了这些对绝望死亡可能性指标的影响。
该研究是对2015 - 2019年来自201,846名《全国药物使用和健康调查》（NSDUH）受访者公开数据的回顾性横断面分析，该调查使用标准化量表和诊断定义来衡量心理症状和物质使用行为。绝望死亡可能性指标包括肝硬化、过去一年的严重自杀意念、根据凯斯勒6量表衡量的严重心理困扰，以及活跃的物质使用障碍（例如，过去一个月内有≥5次暴饮、非医疗使用处方管制物质和非法药物使用）。使用适合NSDUH复杂抽样设计的统计软件和检验进行双变量、年龄分层双变量和多变量逻辑回归分析。协变量包括人口统计学特征、慢性病和宗教活动参与情况。
指标与年龄密切且一致相关，19 - 25岁的受访者中有45.5%经历过≥1项指标，≥65岁的受访者中有10.7%经历过（P <.01）。年龄分层后，服役时期效应较小，仅在≥35岁的成年人中出现。与服役相关的最大增加发生在35 - 49岁的成年人中；1975年开始服役或之后服役与≥1项指标（退伍军人患病率为30.2% - 34.2%，非退伍军人为25.2%）或≥2项指标（退伍军人患病率为6.4% - 8.2%，非退伍军人为5.4%）的患病率增加相关（P <.01）。协变量调整后的结果相似，≥1项指标的调整概率随着年龄增长稳步下降：在19 - 34岁的人群中，非退伍军人中有39.9%，海湾战争/阿富汗战争退伍军人中有42.2%；在≥65岁的人群中，非退伍军人中有10.3%，二战/朝鲜战争退伍军人中有9.2%，越南战争退伍军人中有14.4%。
在考虑年龄因素后，服役时期对绝望死亡可能性的影响较小但可辨别。由于绝望死亡的潜在原因可能因服役时期而异（例如，老年人对越南战争服役的敌意与海湾战争和阿富汗战争中的环境暴露），治疗不同年龄段退伍军人的医疗服务提供者应敏感于与时期相关的影响。研究结果表明询问心理困扰症状并积极促使受影响的个人（退伍军人或非退伍军人）接受适当治疗以预防绝望死亡的重要性。
