Fontana A, Rosenheck R
VA Northeast Program Evaluation Center, West Haven, CT 06516.
Am J Psychiatry. 1995 Jan;152(1):102-9. doi: 10.1176/ajp.152.1.102.
Data from the National Vietnam Veterans Readjustment Study, conducted from 1986 to 1988, were used to develop an etiological model of attempted suicide among a community sample of 1,198 male Vietnam veterans.
In a three-step process, the authors used structural equation modeling to develop a model that they refined, cross-validated, and then specified in terms of its replicable paths.
The final model possesses highly satisfactory fit and parsimony. General psychiatric disorders were the sole factors contributing directly to attempted suicide. General psychiatric disorders were in part products of both nonmilitary and military traumas, most specifically participation in abusive violence. Posttraumatic stress disorder (PTSD) and substance abuse were related to attempted suicide bivariately but not when considered in conjunction with general psychiatric disorders. Among premilitary risk factors, family instability contributed to attempted suicide indirectly through its influence on general psychiatric disorders.
The etiology of attempted suicide among Vietnam veterans remains largely unexplained. A partial explanation is that the predominant and direct causes spring from general psychiatric disorders rather than from traumatic exposure, PTSD, or substance abuse. Traumatic exposure contributes directly to the development of PTSD and general psychiatric disorders but only indirectly to making a suicide attempt.
利用1986年至1988年开展的越南退伍军人全国重新适应研究的数据，构建一个针对1198名男性越南退伍军人社区样本中自杀未遂情况的病因模型。
作者采用三步法，运用结构方程模型构建一个模型，对其进行完善、交叉验证，然后根据可重复路径进行明确。
最终模型具有高度令人满意的拟合度和简约性。一般精神障碍是直接导致自杀未遂的唯一因素。一般精神障碍部分是非军事创伤和军事创伤的产物，最具体的是参与虐待性暴力。创伤后应激障碍（PTSD）和药物滥用与自杀未遂单变量相关，但与一般精神障碍同时考虑时则不然。在入伍前的风险因素中，家庭不稳定通过其对一般精神障碍的影响间接导致自杀未遂。
越南退伍军人自杀未遂的病因在很大程度上仍未得到解释。部分解释是，主要和直接原因源于一般精神障碍，而非创伤暴露、PTSD或药物滥用。创伤暴露直接导致PTSD和一般精神障碍的发展，但仅间接导致自杀未遂。
