Department of Psychiatry (Luu, Campbell-Sills, Stein) and Herbert Wertheim School of Public Health and Human Longevity Science (Sun, Jain, Stein), University of California San Diego, La Jolla; Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Psychiatry, Uniformed Services University, Bethesda (Ursano).
Psychiatr Serv. 2023 Aug 1;74(8):809-815. doi: 10.1176/appi.ps.20220248. Epub 2023 Mar 6.
Military personnel frequently report discontinuing or not pursuing psychiatric treatment despite perceiving a need for services. This study aimed to examine how unmet need for treatment or support among U.S. Army soldiers relates to future suicidal ideation (SI) or suicide attempt (SA).
Mental health treatment need and help seeking in the past 12 months were evaluated for soldiers (N=4,645) who subsequently deployed to Afghanistan. Weighted logistic regression models were used to examine the prospective association of predeployment treatment needs with SI and SA during and after deployment, with adjustment for potential confounders.
Compared with soldiers without predeployment treatment needs, those who reported not seeking help despite needing it had increased risk for SI during deployment (adjusted OR [AOR]=1.73), past-30-day SI at 2-3 months postdeployment (AOR=2.08), past-30-day SI at 8-9 months postdeployment (AOR=2.01), and SA through 8-9 months postdeployment (AOR=3.65). Soldiers who sought help and stopped treatment without improvement had elevated SI risk at 2-3 months postdeployment (AOR=2.35). Those who sought help and stopped after improving did not have increased SI risk during or 2-3 months after deployment but had elevated risks for SI (AOR=1.71) and SA (AOR=3.43) by 8-9 months postdeployment. Risks for all suicidality outcomes were also elevated among soldiers who reported receiving ongoing treatment before deployment.
Unmet or ongoing needs for mental health treatment or support before deployment are associated with increased risk for suicidal behavior during and after deployment. Detecting and addressing treatment needs among soldiers before deployment may help prevent suicidality during deployment and reintegration periods.
军人经常报告中断或不寻求精神科治疗，尽管他们认为需要服务。本研究旨在研究美国陆军士兵的治疗或支持需求未得到满足与未来自杀意念（SI）或自杀企图（SA）之间的关系。
评估了过去 12 个月内在阿富汗部署的士兵（N=4645）的心理健康治疗需求和寻求帮助情况。使用加权逻辑回归模型，在调整潜在混杂因素后，研究了部署前的治疗需求与部署期间和之后的 SI 和 SA 的前瞻性关联。
与没有部署前治疗需求的士兵相比，那些尽管需要但未寻求帮助的士兵在部署期间发生 SI 的风险增加（调整后的比值比[OR] = 1.73），2-3 个月时出现 SI 的风险（OR=2.08），8-9 个月时出现 SI 的风险（OR=2.01），以及 8-9 个月时发生 SA 的风险（OR=3.65）。寻求帮助但治疗未改善而停止治疗的士兵在 2-3 个月时出现 SI 的风险增加（OR=2.35）。寻求帮助并在改善后停止治疗的士兵在部署期间或 2-3 个月内没有增加 SI 的风险，但在 8-9 个月时发生 SI（OR=1.71）和 SA（OR=3.43）的风险增加。在部署前接受持续治疗的士兵，所有自杀风险的发生率也升高。
在部署前未满足或持续存在的心理健康治疗或支持需求与部署期间和之后发生自杀行为的风险增加有关。在部署前发现和解决士兵的治疗需求可能有助于预防部署期间和重新融入期间的自杀。
