VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Psychiatr Res. 2022 May;149:54-61. doi: 10.1016/j.jpsychires.2022.02.016. Epub 2022 Feb 21.
While suicide prevention is a national priority, particularly among service members and veterans (SMVs), understanding of suicide-related outcomes remains poor. Person-centered approaches (e.g., latent class analysis) have promise to identify unique risk profiles and subgroups in the larger population. The current study identified latent subgroups characterized by prior self-directed violence history and proximal risk factors for suicide among suicide attempt survivors, and compared subgroups on demographics and most-lethal attempt characteristics. Participants included civilians and SMVs reporting lifetime suicide attempt(s) (n = 2643) from the Military Suicide Research Consortium. Two classes emerged from Common Data Elements: suicide attempt and non-suicidal self-injury frequency, suicide attempt method, perceived likelihood of future suicide, suicide disclosure, suicide intent, and perceived and actual lethality of attempt. A Higher-Risk History class was characterized by greater intent to die, certainty about attempt fatality and method lethality, belief injury would be medically unfixable, and likelihood of prior non-suicidal self-injury. A Lower-Risk History class was characterized by greater ambivalence toward death and methods. Higher-Risk class members were more likely to be male, older, SMVs, have less formal education, use firearms as most-lethal attempt method, and require a higher degree of medical attention. Lower-Risk class members were more likely to be female, civilian, use cutting as most-lethal attempt method, and require less medical attention for attempts. Findings have implications for risk assessments and highlight the importance of subjective perceptions about suicidal behavior. Further investigation of real-time individual-level is necessary, especially for SMVs who may be at greatest risk for potentially lethal suicidal behavior.
虽然预防自杀是国家的重点工作,尤其是针对军人和退伍军人(SMV),但人们对自杀相关结果的理解仍然有限。以个人为中心的方法(例如,潜在类别分析)有希望在更大的人群中确定独特的风险概况和亚组。本研究在自杀未遂幸存者中,根据既往的自我伤害史和近期自杀风险因素,确定了具有特征的潜在亚组,并比较了亚组在人口统计学和最致命尝试特征方面的差异。参与者包括来自军事自杀研究联盟的报告有终身自杀企图史(n=2643)的平民和军人。从常见数据元素中出现了两个类别:自杀企图和非自杀性自我伤害的频率、自杀企图方法、未来自杀的可能性、自杀披露、自杀意图以及尝试的感知和实际致命性。一个高风险史类别的特点是死亡意愿更强、对尝试致命性和方法致命性的确定性更高、认为伤害将无法通过医学手段修复,以及之前非自杀性自我伤害的可能性更高。低风险史类别的特点是对死亡和方法的态度更为矛盾。高风险类别的成员更可能是男性、年龄较大、军人、受教育程度较低、使用枪支作为最致命的尝试方法,并且需要更高程度的医疗关注。低风险类别的成员更可能是女性、平民、使用切割作为最致命的尝试方法,并且对尝试的医疗关注较少。这些发现对风险评估具有启示意义,并强调了对自杀行为的主观看法的重要性。需要进一步对实时个体水平进行研究,特别是对那些可能面临最致命自杀行为风险的军人。