Health Outcomes Military Exposures, Veterans Health Administration, Department of Veterans Affairs (VA), Washington, DC.
Veterans Integrated Service Network (VISN) 2, Center of Excellence for Suicide Prevention, Department of VA, Washington, DC.
JAMA Netw Open. 2023 Dec 1;6(12):e2347616. doi: 10.1001/jamanetworkopen.2023.47616.
There are persistent questions about suicide deaths among US veterans who served in the Vietnam War. It has been believed that Vietnam War veterans may be at an increased risk for suicide.
To determine whether military service in the Vietnam War was associated with an increased risk of suicide, and to enumerate the number of suicides and analyze patterns in suicides among Vietnam War theater veterans compared with the US population.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study compiled a roster of all Vietnam War-era veterans and Vietnam War theater veterans who served between February 28, 1961, and May 7, 1975. The 2 cohorts included theater veterans, defined as those who were deployed to the Vietnam War, and nontheater veterans, defined as those who served during the Vietnam War era but were not deployed to the Vietnam War. Mortality in these 2 cohorts was monitored from 1979 (beginning of follow-up) through 2019 (end of follow-up). Data analysis was performed between January 2022 and July 2023.
The outcome of interest was death by suicide occurring between January 1, 1979, and December 31, 2019. Suicide mortality was ascertained from the National Death Index. Hazard ratios (HRs) that reflected adjusted associations between suicide risk and theater status were estimated with Cox proportional hazards regression models. Standardized mortality rates (SMRs) were calculated to compare the number of suicides among theater and nontheater veterans with the expected number of suicides among the US population.
This study identified 2 465 343 theater veterans (2 450 025 males [99.4%]; mean [SD] age at year of entry, 33.8 [6.7] years) and 7 122 976 nontheater veterans (6 874 606 males [96.5%]; mean [SD] age at year of entry, 33.3 [8.2] years). There were 22 736 suicides (24.1%) among theater veterans and 71 761 (75.9%) among nontheater veterans. After adjustments for covariates, Vietnam War deployment was not associated with an increased risk of suicide (HR, 0.94; 95% CI, 0.93-0.96). There was no increased risk of suicide among either theater (SMR, 0.97; 95% CI, 0.96-0.99) or nontheater (SMR, 0.97; 95% CI, 0.97-0.98) veterans compared with the US population.
This cohort study found no association between Vietnam War-era military service and increased risk of suicide between 1979 and 2019. Nonetheless, the 94 497 suicides among all Vietnam War-era veterans during this period are noteworthy and merit the ongoing attention of health policymakers and mental health professionals.
关于在美国越南战争期间服役的退伍军人自杀死亡的问题仍然存在。人们一直认为，越南战争退伍军人的自杀风险可能会增加。
确定在越南战争中服役是否与自杀风险增加有关，并列举越南战争战区退伍军人与美国人口相比的自杀人数，并分析自杀模式。
设计、地点和参与者：这项队列研究编制了一份所有越南战争时期退伍军人和在 1961 年 2 月 28 日至 1975 年 5 月 7 日期间部署到越南战争的越南战争战区退伍军人名单。这两个队列包括战区退伍军人，定义为被部署到越南战争的军人，和非战区退伍军人，定义为在越南战争期间服役但未被部署到越南战争的军人。从 1979 年（随访开始）到 2019 年（随访结束）监测这两个队列的死亡率。数据分析于 2022 年 1 月至 2023 年 7 月进行。
感兴趣的结果是在 1979 年 1 月 1 日至 1979 年 12 月 31 日期间发生的自杀死亡。自杀死亡率是从国家死亡指数中确定的。使用 Cox 比例风险回归模型估计了反映自杀风险与战区状况之间调整关联的风险比 (HR)。标准化死亡率 (SMR) 用于比较战区和非战区退伍军人的自杀人数与美国人口的预期自杀人数。
这项研究确定了 2465343 名战区退伍军人（2450025 名男性[99.4%]；入伍时的平均[SD]年龄为 33.8[6.7]岁）和 7122976 名非战区退伍军人（6874606 名男性[96.5%]；入伍时的平均[SD]年龄为 33.3[8.2]岁）。在战区退伍军人中有 22736 例自杀（24.1%），在非战区退伍军人中有 71761 例自杀（75.9%）。调整了协变量后，越南战争部署与自杀风险增加无关（HR，0.94；95%CI，0.93-0.96）。战区（SMR，0.97；95%CI，0.96-0.99）或非战区（SMR，0.97；95%CI，0.97-0.98）退伍军人的自杀风险均无增加与美国人口相比。
这项队列研究发现，在 1979 年至 2019 年期间，越南战争期间的兵役与自杀风险增加之间没有关联。尽管如此，在这段时间内，所有越南战争时期退伍军人中有 94497 人自杀，这值得卫生政策制定者和精神卫生专业人员的持续关注。
