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
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, VeteransCitas
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