Intentos de suicidio y lesiones autoinfligidas en una cohorte nacional de veteranos con trastorno de estrés postraumático y lesión cerebral traumática / Suicide Attempts and Self-Inflicted Injury Among a National Cohort of Veterans with Post-Traumatic Stress Disorder and Traumatic Brain Injury

Olurinde A. Oni, Vikas Singh, Rishi Sharma, Mukut Sharma, Ram Sharma, Mary Oehlert, Hemant Thakur

Resumen


Las tasas de suicidio están aumentando a nivel mundial. Muchas de los suicidios consumados conllevan intentos previos. La identificación de riesgos en los intentos de suicidio puede proporcionar una oportunidad para lograr intervenciones rápidas y focalizadas en la prevención del suicidio. El objetivo de este estudio fue determinar la incidencia de intentos de suicidio y lesiones autoinfligidas (ISLA), y sus asociaciones con SEPT (síndrome de estrés postraumático) y/o LCG (lesión cerebral grave) relacionados con el despliegue militar y los intentos de suicidio. El objeto del estudio fue una gran cohorte nacional de veteranos desplegados antes y después del 11 de septiembre de 2001, que recibieron atención de la Administración de Salud de Veteranos (ASV) entre 1998 y 2014.
Métodos : Se usaron datos clínicos de más de 1,400 establecimientos de ASV proporcionados por la Infraestructura de Informática y Computación de las Administraciones de Veteranos (IICAV), para la realización de análisis descriptivos y de regresión de Cox.
Resultados : Hubo 1.327.604 pacientes en el estudio. De estos, algunos sólo tenían un diagnóstico de SEPT (1.121.818), otros sólo fueron diagnosticados con LCG (100.033), y otros tantos fueron diagnosticados con SEPT y LCG (105.753). La incidencia de ISLA en toda la cohorte fue de 351 por 100,000 años-persona. En el grupo con diagnóstico de SEPT esta tasa fue de 323, y en el grupo LCG fue de 181, mientras que en el grupo de SEPT y LCG fue de 835. En comparación al grupo con LCG, el riesgo ajustado de ISLA fue mayor en el grupo con SEPT (HR = 1.129; IC del 95% = 1.063 - 1.200) y mucho mayor en aquellos con SEPT y LCG (HR = 2.283; IC del 95% = 2.136 - 2.441). El riesgo de ISLA fue mayor para aquellos menores de 50 años, los divorciados o separados, las personas sin hogar, las mujeres no hispanas, aquellos que sufrieron abuso y negligencia como adultos, aquellos con un historial de abuso de sustancias, así como aquellos con ansiedad generalizada y trastornos de personalidad antisocial, y aquellos que estuvieron en el servicio militar antes del 9/11. La proporción de personas que intentaron suicidarse aumentó cada año posterior al diagnóstico de SEPT y/o LCG.

Conclusión : Recomendamos priorizar los recursos para la prevención del suicidio entre los grupos de riesgo.
Palabras clave: intento de suicidio, lesión autoinfligida, trastorno de estrés postraumático, lesión cerebral grave, veteranos


Abstract

Background: Suicide rates are on the rise globally. Many suicide completers are previous attempters. Risk identification of attempters will provide an opportunity for prompt and targeted intervention towards suicide prevention. The aim of this study was to determine the incidence of suicide attempt and self-inflicted injury (SASI), and its associations with deployment-related PTSD and/or TBI and attempted suicide among a large national cohort of Veterans deployed pre and post-9/11 2001 who received care from the Veterans Health Administration (VHA) between 1998 - 2014.
Methods: Clinical data from over 1,400 VHA establishments provided by the Veterans Administrations Informatics and Computing Infrastructure (VINCI) were used for descriptive and Cox regression analyses.
Results: There were 1,327,604 patients in the study - PTSD only (1,121,818), TBI only (100,033), both PTSD and TBI (105,753). The incidence of SASI in the entire cohort was 351 per 100,000 person years; PTSD only (323), TBI only (181), both PTSD and TBI (835). Compared to TBI only group, the adjusted risk for SASI was higher in the PTSD only group (HR=1.129; 95% CI =1.063 - 1.200) and much higher in those with both PTSD and TBI (HR=2.283; 95% CI =2.136 - 2.441). The risk of SASI was higher if they were younger than 50 years, divorced or separated, non-Hispanic females, homeless, suffered adult abuse and neglect, had substance use, generalized anxiety and antisocial personality disorders, and if they were in the Pre-9/11 service period. Proportion of people attempting suicide increased every year post-diagnosis of PTSD and/or TBI.
Conclusion: We recommend prioritizing resources to prevent suicide among at risk groups.

Keywords: suicide attempt, self-inflicted injury, post-traumatic stress disorder, traumatic brain injury, Veterans

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Referencias


World Health Organization. “Suicide.” https://www.who.int/news-room/fact-sheets/detail/suicide. Accessed February 27, 2019.

American Foundation for Suicide Prevention. “Suicide Statistics.” https://afsp.org/about-suicide/suicide-statistics/. Accessed February 27, 2019.

Centers for Disease Control and Prevention. “Data & Statistics Fatal Injury Report for 2017.” 2019. https://www.cdc.gov/injury/wisqars/index.html. Accessed February 27, 2019.

Gebremariam EH, Reta MM, Nasir Z, Amdie FZ. Prevalence and Associated Factors of Suicidal Ideation and Attempt among People Living with HIV/AIDS at Zewditu Memorial Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Study. Psychiatry J. 2017; 2017:2301524.

Centers for Disease Control and Prevention. “National Violent Death Reporting System

(NVDRS).” 2015. https://www.cdc.gov/violenceprevention/datasources/nvdrs/index.html. Accessed February 27, 2019.

Schwartz-Lifshitz M, Zalsman G, Giner L, Oquendo MA. Can we really prevent suicide? Curr Psychiatry Rep. 2012;14(6):624-33.

Bach SL, Molina MAL, Jansen K, da Silva RA, Souza LDM. Suicide risk and childhood trauma in individuals diagnosed with posttraumatic stress disorder. Trends Psychiatry Psychother. 2018;40(3):253-7.

Fralick M, Thiruchelvam D, Tien HC, Redelmeier DA. Risk of suicide after a concussion. CMAJ. 2016;188(7):497-504.

Stone DM, Simon TR, Fowler KA, et al. Vital Signs: Trends in State Suicide Rates - United States, 1999-2016 and Circumstances Contributing to Suicide - 27 States, 2015. MMWR Morb Mortal Wkly Rep. 2018;67(22):617-24.

Bullman T, Schneiderman A, Gradus JL. Relative Importance of Posttraumatic Stress Disorder and Depression in Predicting Risk of Suicide among a Cohort of Vietnam Veterans. Suicide Life Threat Behav. 2018.

Centers for Disease Control and Prevention. “Suicide rising across the US.” vitalsigns [Internet]. 2018. https://www.cdc.gov/vitalsigns/pdf/vs-0618-suicide-H.pdf. Accessed February 27, 2019.

Ahmedani BK, Simon GE, Stewart C, et al. Health care contacts in the year before suicide death. J Gen Intern Med. 2014;29(6):870-7.

Leavey G, Rosato M, Galway K, Hughes L, Mallon S, Rondon J. Patterns and predictors of help-seeking contacts with health services and general practitioner detection of suicidality prior to suicide: a cohort analysis of suicides occurring over a two-year period. BMC Psychiatry. 2016;16:120.

Rosellini AJ, Street AE, Ursano RJ, et al. Sexual Assault Victimization and Mental Health Treatment, Suicide Attempts, and Career Outcomes Among Women in the US Army. Am J Public Health. 2017;107(5):732-9.

Boggs JM, Simon GE, Ahmedani BK, Peterson E, Hubley S, Beck A. The Association of Firearm Suicide With Mental Illness, Substance Use Conditions, and Previous Suicide Attempts. Ann Intern Med. 2017;167(4):287-8.

Barnes SM, Walter KH, Chard KM. Does a history of mild traumatic brain injury increase suicide risk in veterans with PTSD? Rehabil Psychol. 2012;57(1):18-26.

Brenner LA, Betthauser LM, Homaifar BY, et al. Posttraumatic stress disorder, traumatic brain injury, and suicide attempt history among veterans receiving mental health services. Suicide Life Threat Behav. 2011;41(4):416-23.

Fonda JR, Fredman L, Brogly SB, McGlinchey RE, Milberg WP, Gradus JL. Traumatic Brain Injury and Attempted Suicide Among Veterans of the Wars in Iraq and Afghanistan. Am J Epidemiol. 2017;186(2):220-6.

Schneider AL, Hostetter TA, Homaifar BY, et al. Responses to Traumatic Brain Injury Screening Questions and Suicide Attempts among Those Seeking Veterans Health Administration Mental Health Services. Front Psychiatry. 2016;7:59.

US Department of Veterans Affairs. “VHA Corporate Data Warehouse.” https://www.hsrd.research.va.gov/for_researchers/vinci/cdw.cfm. Accessed February 27, 2019.

VA Office of Public and Intergovernmental Affairs. “VA Releases Veteran Suicide Statistics by State.” https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2951. Accessed February 27, 2019.

Canner JK, Giuliano K, Selvarajah S, Hammond ER, Schneider EB. Emergency department visits for attempted suicide and self harm in the USA: 2006-2013. Epidemiol Psychiatr Sci. 2018;27(1):94-102.

Ting SA, Sullivan AF, Boudreaux ED, Miller I, Camargo CA, Jr. Trends in US emergency department visits for attempted suicide and self-inflicted injury, 1993-2008. Gen Hosp Psychiatry. 2012;34(5):557-65.

Ursano RJ, Kessler RC, Stein MB, et al. Suicide Attempts in the US Army During the Wars in Afghanistan and Iraq, 2004 to 2009. JAMA Psychiatry. 2015;72(9):917-26.

Drapeau, CW., & McIntosh, JL. U.S.A. suicide 2017: Official final data., American Association of Suicidology http://www.suicidology.org. Accessed February 27, 2019.

Olfson M, Blanco C, Wall M, et al. National Trends in Suicide Attempts Among Adults in the United States. JAMA Psychiatry. 2017;74(11):1095-103

Rosellini AJ, Street AE, Ursano RJ, et al. Sexual Assault Victimization and Mental Health Treatment, Suicide Attempts, and Career Outcomes Among Women in the US Army. Am J Public Health. 2017;107(5):732-9.

Naifeh JA, Ursano RJ, Kessler RC, Gonzalez OI, Fullerton CS, Herberman Mash HB, et al. Suicide attempts among activated soldiers in the U.S. Army reserve components. BMC Psychiatry. 2019;19(1):31.

Ursano RJ, Kessler RC, Stein MB, et al. Risk Factors, Methods, and Timing of Suicide Attempts Among US Army Soldiers. JAMA Psychiatry. 2016;73(7):741-9.

Boren EA, Folk JB, Loya JM, Tangney JP, Barboza SE, Wilson JS. The Suicidal Inmate: A Comparison of Inmates Who Attempt Versus Complete Suicide. Suicide Life Threat Behav. 2018;48(5):570-9.

Sun L, Zhang J. Gender differences among medically serious suicide attempters aged 15-54 years in rural China. Psychiatry Res. 2017;252:57-62.

Choi KH, Wang SM, Yeon B, et al. Risk and protective factors predicting multiple suicide attempts. Psychiatry Res. 2013;210(3):957-61.

Ursano RJ, Kessler RC, Stein MB, et al. Risk Factors, Methods, and Timing of Suicide Attempts Among US Army Soldiers. JAMA Psychiatry. 2016;73(7):741-9.

Jones AL, Hausmann LRM, Haas GL, et al. A national evaluation of homeless and nonhomeless veterans' experiences with primary care. Psychol Serv. 2017;14(2):174-83.

Tsai J, Rosenheck RA. Risk factors for homelessness among US veterans. Epidemiol Rev. 2015;37:177-95.

Tsai J, Cao X. Association between suicide attempts and homelessness in a population-based sample of US veterans and non-veterans. J Epidemiol Community Health. 2019.

Blasco-Fontecilla H, Baca-Garcia E, Duberstein P, et al. An exploratory study of the relationship between diverse life events and specific personality disorders in a sample of suicide attempters. J Pers Disord. 2010;24(6):773-84.

Britton PC, Bohnert KM, Ilgen MA, Kane C, Stephens B, Pigeon WR. Suicide mortality among male veterans discharged from Veterans Health Administration acute psychiatric units from 2005 to 2010. Soc Psychiatry Psychiatr Epidemiol. 2017;52(9):1081-7

Dong X, Chen R, Wu B, Zhang NJ, Mui AC, Chi I. Association between Elder Mistreatment and Suicidal Ideation among Community-Dwelling Chinese Older Adults in the USA. Gerontology. 2015;62(1):71-80.

Wu L, Shen M, Chen H, et al. The relationship between elder mistreatment and suicidal ideation in rural older adults in China. Am J Geriatr Psychiatry. 2013;21(10):1020-8.

McCauley E, Berk MS, Asarnow JR, et al. Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial. JAMA Psychiatry. 2018;75(8):777-85.

Cwik MF, Tingey L, Maschino A, et al. Decreases in Suicide Deaths and Attempts Linked to the White Mountain Apache Suicide Surveillance and Prevention System, 2001-2012. Am J Public Health. 2016;106(12):2183-9.

Thakur H, Oni O, Singh V, et al. Increases in the Service Connection Disability and Treatment Costs Associated With Posttraumatic Stress Disorder and/or Traumatic Brain Injury in United States Veterans Pre- and Post-9/11: The Strong Need for a Novel Therapeutic Approach. Epidemiology (Sunnyvale). 2018;8:353.

Han B, Compton WM, Gfroerer J, McKeon R. Mental health treatment patterns among adults with recent suicide attempts in the United States. Am J Public Health. 2014;104(12):2359-68.

Bhatt M, Perera S, Zielinski L, et al. Profile of suicide attempts and risk factors among psychiatric patients: A case-control study. PLoS One. 2018;13(2):e0192998.

Matthay EC, Galin J, Ahern J. Changing Patterns in Rates and Means of Suicide in California, 2005 to 2013. Am J Public Health, 2017;107(3), 427-429.

Lee J, Jang H, Kim J, Min S. Development of a suicide index model in general adolescents using the South Korea 2012-2016 national representative survey data. Sci Rep. 2019;9(1):1846


 

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