Sher Leo
Inpatient Psychiatry, James J. Peters VA Medical Center, Bronx, NY, USA.
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
QJM. 2024 Mar 27;117(3):163-167. doi: 10.1093/qjmed/hcad240.
Military conflicts are ubiquitous. There are a lot of combat veterans around the world. Suicidality in combat veterans is a large and important issue. In this article, the author discusses some aspects of this issue. The combat environment is characterized by violence, physical strains, separation from loved ones and other hardships. Combat deployment may lead to multiple emotional, cognitive, psychosomatic symptoms, suicidal ideation and behavior. Pre-deployment, deployment and post-deployment adversities may increase suicide risk in combat veterans. The act of killing in combat is a stressor which may raise suicide risk. Combat-related injuries are associated with increased suicide risk. Post-deployment difficulties of reintegrating into civilian life may lead to depression and suicidality. Studies suggest that suicidal behavior in combat veterans may have a neurobiological basis. Prevention of suicide among combat veterans should include pre-deployment screening to exclude individuals with psychiatric disorders; psychological support and prevention of harassment and/or abuse during deployment; psychosocial support after deployment; diagnosing and treating psychiatric and medical disorders including neurological disorders; frequent suicide screening; education of mental and non-mental health clinicians, war veterans, their families and friends regarding signs/symptoms of suicidality; and restriction of access to lethal means. We need to study the specific psychobiology of combat veterans to understand how to develop effective suicide prevention interventions for this population.
军事冲突无处不在。世界各地有许多退伍军人。退伍军人的自杀问题是一个重大且重要的议题。在本文中，作者探讨了该问题的一些方面。战斗环境的特点是暴力、身体劳损、与亲人分离以及其他艰难困苦。战斗部署可能导致多种情绪、认知、心身症状、自杀念头和行为。部署前、部署中和部署后的逆境可能会增加退伍军人的自杀风险。在战斗中杀人这一行为是一种应激源，可能会提高自杀风险。与战斗相关的损伤与自杀风险增加有关。部署后重新融入平民生活的困难可能导致抑郁和自杀行为。研究表明，退伍军人的自杀行为可能有神经生物学基础。预防退伍军人自杀应包括部署前筛查以排除患有精神疾病的个体；部署期间提供心理支持以及预防骚扰和/或虐待；部署后提供社会心理支持；诊断和治疗包括神经系统疾病在内的精神和躯体疾病；定期进行自杀筛查；对精神科和非精神科临床医生、退伍军人及其家人和朋友进行关于自杀迹象/症状的教育；以及限制获取致命手段。我们需要研究退伍军人的具体心理生物学，以了解如何为这一群体制定有效的自杀预防干预措施。
