Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA.
Mil Med. 2024 Jul 3;189(7-8):e1642-e1652. doi: 10.1093/milmed/usad457.
Most research on suicide attempts among U.S. service members has been focused on risk factors that occur during service. There is an important gap in our understanding of premilitary factors, such as personality characteristics, that may be associated with future suicide attempt risk during service. Of particular importance is identifying risk factors for the 1/3 of suicide attempters who never receive a mental health diagnosis (MH-Dx)-and therefore are not identified as having a mental health problem in the military healthcare system-prior to their suicide attempt.
Using two components of the Army Study to Assess Risk and Resilience in Servicemembers, we examined the association of personality facets from the Tailored Adaptive Personality Assessment System, a computerized instrument administered prior to entering service, with medically documented suicide attempts during service. A 2010-2016 sample of historical administrative records from U.S. Regular Army enlisted soldiers with complete data on 11 commonly administered Tailored Adaptive Personality Assessment System facets was examined using a series of logistic regression analyses to identify the facets associated with future suicide attempt. Significant facets were then applied to data from a longitudinal cohort study of 11,288 soldiers surveyed upon entering basic combat training and followed via administrative records for their first 48 months of service. This research was approved by the Institutional Review Boards at the collaborating institutions.
Analysis of the historical administrative data (87.0% male, 61.6% White non-Hispanic), found that low Optimism (odds ratio (OR) = 1.2 [95% CI = 1.0-1.4]) and high/low (vs. moderate) Sociability (OR = 1.3 [95%CI = 1.1-1.6]) were associated with suicide attempt after adjusting for other univariable-significant facets and socio-demographic and service-related variables. When examined in the longitudinal survey cohort, low Optimism (OR = 1.7 [95% CI = 1.1-2.4]) and high/low (vs. moderate) Sociability (OR = 1.7 [95% CI = 1.1-2.5]) were still associated with increased odds of documented suicide attempt during service, even after adjusting for each other, socio-demographic and service-related variables, and medically documented MH-Dx. Mental health diagnosis had a significant two-way interaction with Optimism (F = 5.27, p = 0.0236) but not Sociability. Stratified analyses indicated that low Optimism was associated with suicide attempt among soldiers without, but not among those with, a MH-Dx. Interactions of Optimism and Sociability with gender were nonsignificant. In the full model, population attributable risk proportions for Optimism and Sociability were 15.0% and 18.9%, respectively. Optimism and Sociability were differentially associated with suicide attempt risk across time in service.
Optimism and Sociability, assessed prior to entering U.S. Army service, are consistently associated with future suicide attempt during service, even after adjusting for other important risk factors. While Sociability is equally associated with suicide attempt among those with and without a MH-Dx, Optimism is specifically associated with suicide attempt among soldiers not identified in the mental healthcare system. Risk differences across time in service suggest that Optimism and Sociability interact with stressors and contextual factors in particular developmental and Army career phases.
大多数关于美国军人自杀未遂的研究都集中在服役期间发生的风险因素上。我们对入伍前的因素，如人格特征，知之甚少，这些因素可能与服役期间未来的自杀未遂风险有关。特别重要的是，要在自杀未遂之前，确定那些从未接受过心理健康诊断（MH-Dx）的三分之一自杀未遂者（因此，在军队医疗保健系统中，他们没有被认为有心理健康问题）的风险因素。
使用军人研究中评估风险和复原力的两个组成部分，我们研究了 Tailored Adaptive Personality Assessment System 的人格特征与服役期间有医学记录的自杀未遂之间的关联。Tailored Adaptive Personality Assessment System 是一种在入伍前使用的计算机化工具，我们使用了 2010 年至 2016 年美国正规军入伍士兵的历史行政记录的一个样本，这些士兵在完成 11 个常见的 Tailored Adaptive Personality Assessment System 特征的完整数据，使用一系列逻辑回归分析来确定与未来自杀企图相关的特征。然后，将显著的特征应用于 11288 名士兵的纵向队列研究的数据中，这些士兵在基本战斗训练时接受了调查，并通过行政记录在服役的前 48 个月进行了随访。这项研究得到了合作机构机构审查委员会的批准。
对历史行政数据（87.0%为男性，61.6%为白人非西班牙裔）的分析发现，低乐观（优势比（OR）=1.2[95%CI=1.0-1.4]）和高/低（与中值相比）社交性（OR=1.3[95%CI=1.1-1.6]）与调整其他单变量显著特征以及社会人口学和与服务相关的变量后自杀企图相关。当在纵向调查队列中进行检查时，低乐观（OR=1.7[95%CI=1.1-2.4]）和高/低（与中值相比）社交性（OR=1.7[95%CI=1.1-2.5]）仍然与服务期间有记录的自杀企图的几率增加相关，即使在相互调整后，社会人口学和与服务相关的变量以及有医学记录的 MH-Dx 也是如此。心理健康诊断与乐观（F=5.27，p=0.0236）但与社交性（F=2.08，p=0.1525）有显著的双向交互作用。分层分析表明，低乐观与没有 MH-Dx 的士兵的自杀企图有关，但与有 MH-Dx 的士兵的自杀企图无关。乐观和社交性与性别之间的相互作用不显著。在全模型中，乐观和社交性的人群归因风险比例分别为 15.0%和 18.9%。乐观和社交性与服役期间的自杀企图风险在不同时间存在差异。
在进入美国陆军服役之前评估的乐观和社交能力与服役期间的未来自杀企图始终相关，即使在调整了其他重要风险因素之后也是如此。虽然社交能力与 MH-Dx 有或没有 MH-Dx 的自杀企图同样相关，但乐观与未在精神保健系统中确定的士兵的自杀企图特别相关。服务期间风险差异表明，乐观和社交能力与压力源和特定发展和军队职业阶段的背景因素相互作用。
