在美国现役和退役军人的大型人群队列中，对枪支自杀和非枪支自杀风险因素的前瞻性比较：千禧队列研究的结果
Prospective comparison of risk factors for firearm suicide and non-firearm suicide in a large population-based cohort of current and former US service members: findings from the Millennium Cohort Study.
作者信息
LeardMann Cynthia A, Sharifian Neika, Warner Steven, Boyko Edward J, Boparai Satbir K, Powell Teresa M, Rull Rudolph P, Reger Mark A, Hoge Charles W
机构信息
Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA.
Leidos, Inc., San Diego, CA, USA.
出版信息
Lancet Reg Health Am. 2024 Jun 14;36:100802. doi: 10.1016/j.lana.2024.100802. eCollection 2024 Aug.
BACKGROUND
Suicide is a leading cause of death among service members and veterans. Among suicide methods, firearms are the most lethal and commonly used method among military populations. Limited research has compared risk factors for the various suicide methods. This study evaluated and compared risk factors for firearm versus non-firearm suicides using data from the Millennium Cohort Study, a large longitudinal military cohort.
METHODS
Using a competing risk approach, we identified factors associated with each suicide method. Risk factors included demographics, mental health diagnoses, mental health symptoms, military-specific characteristics, health behaviors, and psychosocial factors. Cause of death was assessed from July 1, 2001, through December 31, 2018.
FINDINGS
Among 201,565 eligible participants with a mean [SD] age of 29.0 [58.1] years, there were 139,789 (69.3%) male, 61,776 (30.7%) female, 15,927 (7.9%) Hispanic, 24,667 (12.3%) non-Hispanic Black, 14,138 (7.0%) Asian, Pacific Islander, American Indian or Multiracial, and 146,736 (72.8%) non-Hispanic White participants. During the study period, 330 died by firearm suicide and 168 died by non-firearm suicide. Overall, effect estimates for risk factors were similar across both methods of suicide. After adjustment, men (HR: 3.69, 95% CI: 2.59, 5.24) and those who screened positive for depression (HR: 1.97, 95% CI: 1.36, 2.87) had an elevated risk for firearm suicide. In contrast, those who self-reported a history of bipolar diagnosis (HR: 3.40, 95% CI: 1.76, 6.55) had significantly increased risk for non-firearm suicide.
INTERPRETATION
Findings suggest that prevention and intervention strategies overall may not need to be differentiated by specific demographic, military, or health factors. Targeted interventions that consider sex and mental health screens might have relative utility in preventing firearm related suicide risk compared with non-firearm suicide.
FUNDING
Military Operational Medicine Research Program, Defense Health Program, and Department of Veterans Affairs.
背景
自杀是现役军人和退伍军人死亡的主要原因之一。在自杀方式中，枪支是军事人群中最致命且最常用的方法。比较各种自杀方式风险因素的研究有限。本研究利用千禧队列研究（一项大型纵向军事队列研究）的数据，评估并比较了枪支自杀与非枪支自杀的风险因素。
方法
采用竞争风险方法，我们确定了与每种自杀方式相关的因素。风险因素包括人口统计学特征、心理健康诊断、心理健康症状、军事特定特征、健康行为和社会心理因素。死亡原因评估时间为2001年7月1日至2018年12月31日。
结果
在201,565名符合条件的参与者中，平均年龄为29.0岁（标准差为58.1岁），其中男性139,789人（69.3%），女性61,776人（30.7%），西班牙裔15,927人（7.9%），非西班牙裔黑人24,667人（12.3%），亚裔、太平洋岛民、美洲印第安人或多种族14,138人（7.0%），非西班牙裔白人146,736人（72.8%）。在研究期间，330人死于枪支自杀，168人死于非枪支自杀。总体而言，两种自杀方式的风险因素效应估计相似。调整后，男性（风险比：3.69，95%置信区间：2.59，5.24）和抑郁筛查呈阳性者（风险比：1.97，95%置信区间：1.36，2.87）枪支自杀风险升高。相比之下，自我报告有双相情感障碍诊断史者（风险比：3.40，95%置信区间：1.76，6.55）非枪支自杀风险显著增加。
解读
研究结果表明，总体预防和干预策略可能无需根据特定人口统计学、军事或健康因素进行区分。与非枪支自杀相比，考虑性别和心理健康筛查的针对性干预措施在预防枪支相关自杀风险方面可能具有相对效用。
资助
军事行动医学研究项目、国防健康项目和退伍军人事务部。
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