Hargrave Anita S, Cohen Beth E, Gibson Carolyn J, Keyhani Salomeh, Li Yixia, Boscardin W John, Byers Amy L
Center for Data to Discovery and Delivery Innovation, San Francisco Veterans Affairs Health Care System, and Department of Medicine, University of California, San Francisco, San Francisco, California (A.S.H., B.E.C., S.K.).
Center for Data to Discovery and Delivery Innovation, San Francisco Veterans Affairs Health Care System, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California (C.J.G.).
Ann Intern Med. 2025 Jun;178(6):775-787. doi: 10.7326/ANNALS-24-01145. Epub 2025 Apr 29.
Little is known about the association between military sexual trauma (MST) and risk for suicide-related outcomes later in life.
To determine the association between MST and risk for suicide, overdose, and related mortality among older men and women at specific age landmarks and to investigate whether posttraumatic stress disorder (PTSD) modifies risk.
Longitudinal cohort study; baseline in 2012 to 2013, with follow-up through 31 December 2020.
All U.S. Department of Veterans Affairs (VA) medical centers in the United States.
5 059 526 veterans aged 50 years or older.
Positive MST screening result, nonfatal suicide attempt, death by suicide, or overdose death.
MST was documented for 15.7% of older women and 1.3% of older men. The adjusted cumulative incidence of any suicide attempt was higher for those with MST (men, 18.67%; women, 8.66%) than for those without MST (men, 6.25%; women, 2.92%) at age 90 years. The adjusted risk differences among men and women were 12.41% (95% CI, 11.72% to 13.10%) and 5.74% (CI, 5.22% to 6.26%) for any late-life suicide attempt, 11.92% (CI, 11.27% to 12.57%) and 5.58% (CI, 5.08% to 6.08%) for nonfatal suicide attempt, 0.27% (CI, 0.00% to 0.54%) and 0.15% (CI, 0.00% to 0.30%) for fatal suicide attempt, and 1.05% (CI, 0.79% to 1.31%) and 0.48% (CI, 0.28% to 0.68%) for any drug overdose at age 90 years. MST remained a significant risk factor for any suicide attempt among people with and without PTSD.
Selection bias, generalizability to non-VA veterans, possible unmeasured confounding, and missingness.
Late-life suicide attempt and death by suicide or overdose are associated with prior MST. These findings advance our understanding of the lasting effect of sexual trauma on suicide risk and mortality and suggest that monitoring and treatment of MST-related conditions are vital over the long term.
VA Office of Research and Development.
关于军事性创伤（MST）与晚年自杀相关结局风险之间的关联，目前所知甚少。
确定在特定年龄节点的老年男性和女性中，MST与自杀、药物过量及相关死亡率风险之间的关联，并调查创伤后应激障碍（PTSD）是否会改变风险。
纵向队列研究；2012年至2013年为基线期，随访至2020年12月31日。
美国所有退伍军人事务部（VA）医疗中心。
5059526名年龄在50岁及以上的退伍军人。
MST筛查结果呈阳性、非致命性自杀未遂、自杀死亡或药物过量死亡。
记录显示，15.7%的老年女性和1.3%的老年男性存在MST。在90岁时，有MST者（男性为18.67%；女性为8.66%）的任何自杀未遂调整累积发生率高于无MST者（男性为6.25%；女性为2.92%）。90岁时，有MST的男性和女性与无MST者相比，任何晚年自杀未遂的调整风险差异分别为12.41%（95%CI，11.72%至13.10%）和5.74%（CI，5.22%至6.26%），非致命性自杀未遂的差异分别为11.92%（CI，11.27%至12.57%）和5.58%（CI，5.08%至6.08%），致命性自杀未遂的差异分别为0.27%（CI，0.00%至0.54%）和0.15%（CI，0.00%至0.30%），任何药物过量的差异分别为1.05%（CI，0.79%至1.31%）和0.48%（CI，0.28%至0.68%）。在有和没有PTSD的人群中，MST仍然是任何自杀未遂的重要风险因素。
选择偏倚、对非VA退伍军人的可推广性、可能存在未测量的混杂因素以及数据缺失。
晚年自杀未遂以及自杀或药物过量死亡与既往MST有关。这些发现增进了我们对性创伤对自杀风险和死亡率的长期影响的理解，并表明对与MST相关状况的监测和治疗在长期来看至关重要。
VA研发办公室。
