IMPORTANCE: Beginning in 2005, the incidence of suicide deaths in the US military began to sharply increase. Unique stressors, such as combat deployments, have been assumed to underlie the increasing incidence. Previous military suicide studies, however, have relied on case series and cross-sectional investigations and have not linked data during service with postservice periods. OBJECTIVE: To prospectively identify and quantify risk factors associated with suicide in current and former US military personnel including demographic, military, mental health, behavioral, and deployment characteristics. DESIGN, SETTING, AND PARTICIPANTS: Prospective longitudinal study with accrual and assessment of participants in 2001, 2004, and 2007. Questionnaire data were linked with the National Death Index and the Department of Defense Medical Mortality Registry through December 31, 2008. Participants were current and former US military personnel from all service branches, including active and Reserve/National Guard, who were included in the Millennium Cohort Study (N = 151 560). MAIN OUTCOMES AND MEASURES: Death by suicide captured by the National Death Index and the Department of Defense Medical Mortality Registry. RESULTS: Through the end of 2008, findings were 83 suicides in 707 493 person-years of follow-up (11.73/100 000 person-years [95% CI, 9.21-14.26]). In Cox models adjusted for age and sex, factors significantly associated with increased risk of suicide included male sex, depression, manic-depressive disorder, heavy or binge drinking, and alcohol-related problems. None of the deployment-related factors (combat experience, cumulative days deployed, or number of deployments) were associated with increased suicide risk in any of the models. In multivariable Cox models, individuals with increased risk for suicide were men (hazard ratio [HR], 2.14; 95% CI, 1.17-3.92; P = .01; attributable risk [AR], 3.5 cases/10 000 persons), and those with depression (HR, 1.96; 95% CI, 1.05-3.64; P = .03; AR, 6.9/10 000 persons), manic-depressive disorder (HR, 4.35; 95% CI, 1.56-12.09; P = .005; AR, 35.6/10 000 persons), or alcohol-related problems (HR, 2.56; 95% CI, 1.56-4.18; P <.001; AR, 7.7/10 000 persons). A nested, matched case-control analysis using 20:1 control participants per case confirmed these findings. CONCLUSIONS AND RELEVANCE: In this sample of current and former military personnel observed July 1, 2001-December 31, 2008, suicide risk was independently associated with male sex and mental disorders but not with military-specific variables. These findings may inform approaches to mitigating suicide risk in this population.
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机译：重要信息：从2005年开始，美军自杀死亡的发生率开始急剧上升。假定独特的压力源（例如战斗部署）是造成事故增加的基础。但是，以前的军事自杀研究依靠的是病例系列和横断面调查，并且没有将服役期间和服役期间的数据联系起来。目的：前瞻性地识别和量化与现任和前任美国军事人员自杀相关的危险因素，包括人口统计，军事，心理健康，行为和部署特征。设计，地点和参与者：前瞻性纵向研究，对2001、2004和2007年的参与者进行评估和评估。调查问卷数据与美国国家死亡指数和国防部医疗死亡率登记处相关联，直到2008年12月31日为止。以及来自所有服役部门的美国前军事人员，包括现役和预备役/国民警卫队，都被纳入了千年队列研究（N = 151 560）。主要成果和措施：由国家死亡指数和国防部医疗死亡率登记处记录的自杀死亡。结果：到2008年底，在707493人-年的随访中发现83例自杀（11.73 / 100 000人-年[95％CI，9.21-14.26]）。在根据年龄和性别进行调整的Cox模型中，与自杀风险增加显着相关的因素包括男性，抑郁，躁狂抑郁症，酗酒或暴饮暴食以及与酒精有关的问题。在任何模型中，与部署相关的因素（战斗经验，部署的累计天数或部署的数量）均与自杀风险的增加无关。在多变量Cox模型中，自杀风险增加的个体为男性（危险比[HR]为2.14; 95％CI为1.17-3.92; P = 0.01;归因风险[AR]为3.5例/ 10 000人），以及患有抑郁症（HR，1.96; 95％CI，1.05-3.64; P = .03; AR，6.9 / 10 000人），躁狂抑郁症（HR，4.35; 95％CI，1.56-12.09; P =。 005; AR，35.6 / 10 000人）或与酒精相关的问题（HR，2.56; 95％CI，1.56-4.18; P <.001; AR，7.7 / 10 000）。嵌套，匹配的病例对照分析（每个病例使用20：1对照参与者）证实了这些发现。结论和相关性：在本样本中，2001年7月1日至2008年12月31日的现任和前任军事人员样本中，自杀风险与男性和精神障碍独立相关，但与军事特定变量无关。这些发现可能为减轻该人群自杀风险提供了方法。
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