Integrating signals of suicide risk from DoD and VHA data to improve upon suicide risk prevention strategies for combat Veterans

整合来自 DoD 和 VHA 数据的自杀风险信号，以改进退伍军人的自杀风险预防策略

• 批准号: 10437762
• 负责人: Rachel Sayko Adams
• 金额: $ 44.99万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10437762
• 关键词: Age; Algorithms; Behavior; Caring; Cause of Death; Cessation of life; Characteristics; Clinical; Cohort Studies; Data; Data Files; Data Set; Databases; Department of Defense; Distal; Early Intervention; Eligibility Determination; Evaluation; Feeling suicidal; Freedom; Frequencies; Funding; Future; Goals; Health; Health Services Administration; Health Services and Mental Health Administration; Healthcare; Healthcare Systems; Individual; Injury; Intervention; Knowledge; Life; Link; Measures; Medical; Mental Health; Military Personnel; National Center for Complementary and Integrative Health; National Institute of Drug Abuse; Occupations; Outcome; Overdose; Personal Satisfaction; Pharmacy facility; Policies; Policy Maker; Population; Prevention strategy; Process; Public Health; Records; Recovery; Research; Research Personnel; Risk; Risk Assessment; Risk Factors; Sampling; Services; Signal Transduction; Soldier; Subgroup; Suicide; Suicide prevention; Symptoms; Time; Tobacco use; United States Department of Veterans Affairs; Vehicle crash; Veterans; Veterans Health Administration; Visit; Vital Statistics; Work; active duty; base; clinical diagnosis; cohort; combat; combat veteran; demographics; experience; follow-up; hazard; health assessment; health plan; high risk; improved; indexing; large datasets; longitudinal database; member; military health system; military service; military veteran; mortality; operation; pain score; population based; predictive modeling; prevent; programs; prospective; psychologic; risk sharing; risk stratification; secondary outcome; service member; sex; substance use; suicidal behavior; suicidal morbidity; suicidal risk; suicide rate

Abstract Historically, opportunities to link data from the Departments of Defense (DoD) and Veterans Affairs (VA) have been extremely limited. Observing problems that emerge among Soldiers soon after they return from Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) deployments, as well as those that develop overtime and during periods of transition (e.g., between time of deployment and entry into Veterans Health Administration [VHA] care), is expected to increase understanding of how risk for suicide develops. Work outlined in this study will allow the team to merge an existing data set, the Substance Use and Psychological Injury Combat Study (SUPIC), a longitudinal database of over 865,000 Army Active Duty (AD) and National Guard/Reserve Soldiers (NG/RS) returning from OEF/OIF/OND deployments with clinical and administrative data available within the VHA, including National Death Index (NDI) data. Suicide and other cause of death data are available for the entire SUIPIC cohort, regardless of whether or not they have sought VHA care. As outlined in this application, members of this team of interdisciplinary researchers propose linking the SUPIC cohort database to VHA and NDI data, allowing us to examine the following: AIM 1: Estimate post- deployment suicide rates and time dependent suicide hazard rates by service component (i.e., AD, NG/RS), sex, age, and military experience. AIM 2: Among SUPIC Soldiers who have separated (AD) or demobilized (RS/NG) from military service, develop a suicide risk algorithm that incorporates demographic characteristics, military experiences (e.g., combat exposure, military occupation), separation characteristics, and clinical diagnoses. AIM 3: Among SUPIC Veterans, compare those who engaged in VHA services and those that did not. Among those who have engaged in VHA services examine how timing, frequency, and type of VHA services used relate to death by suicide. AIM 4: Evaluate the potential to enhance the VA's use of predictive modeling to identify Veterans at high risk for suicide by incorporating suicide risk factors captured within DoD data. Use of the SUPIC database, which is a large population-based sample, will permit analyses of sub- groups, such as by component, sex, and military experience. Moreover, unlike previous VHA utilization studies, this effort will allow the team to prospectively identify a complete VHA-eligible population by selecting a cohort through DOD records, and tracking these Soldiers longitudinally to observe VHA utilization. Findings from this proposed effort will provide the most comprehensive, empirical evidence to date on characteristics of a post- deployment cohort (i.e., risk factors) in relation to suicide outcomes. Findings are expected to provide policy makers, researchers, and clinicians with critical information to plan for early interventions aimed at reducing proximal and distal negative psychiatric outcomes including death by suicide.

抽象的 从历史上看，链接来自国防部 (DoD) 和退伍军人事务部 (VA) 的数据的机会已经存在 受到了极大的限制。观察士兵从行动返回后不久出现的问题 持久自由/伊拉克自由行动/新黎明行动（OEF/OIF/OND）部署，以及 那些在超时和过渡期间（例如，在部署时间和进入时间之间）发展的 退伍军人健康管理局 [VHA] 护理），预计将增加对自杀风险的了解 发展。本研究中概述的工作将允许团队合并现有的数据集，即物质使用 和心理伤害战斗研究 (SUPIC)，这是一个包含超过 865,000 名陆军现役军人的纵向数据库 (AD) 和国民警卫队/预备役士兵 (NG/RS) 从 OEF/OIF/OND 部署返回并进行临床 VHA 内提供的行政数据，包括国家死亡指数 (NDI) 数据。自杀及其他 整个 SUIPIC 队列的死因数据均可用，无论他们是否寻求过 VHA 护理。正如本申请中所述，该跨学科研究人员团队的成员建议将 SUPIC 队列数据库到 VHA 和 NDI 数据，使我们能够检查以下内容： AIM 1：估计后 按军种（即 AD、NG/RS）划分的部署自杀率和随时间变化的自杀危险率， 性别、年龄和军事经历。目标 2：在分离 (AD) 或复员的 SUPIC 士兵中 (RS/NG) 来自兵役，开发一种结合人口特征的自杀风险算法， 军事经历（例如，战斗暴露、军事占领）、分离特征和临床 诊断。目标 3：在 SUPIC 退伍军人中，比较从事 VHA 服务的人和从事过 VHA 服务的人 不是。从事 VHA 服务的人会检查 VHA 的时间、频率和类型 使用的服务涉及自杀死亡。目标 4：评估增强 VA 使用预测的潜力 通过纳入国防部捕获的自杀风险因素，建立模型来识别自杀高风险的退伍军人 数据。 SUPIC 数据库是一个基于人口的大型样本，使用该数据库将允许对子群体进行分析。 群体，例如按组成、性别和军事经验分类。此外，与之前的 VHA 利用研究不同， 这项工作将使团队能够通过选择队列来前瞻性地确定完整的 VHA 资格人群 通过 DOD 记录，纵向跟踪这些士兵以观察 VHA 的使用情况。由此得出的结论 拟议的努力将提供迄今为止关于后经济特征的最全面的经验证据。 与自杀结果相关的部署队列（即风险因素）。调查结果有望提供政策 制造商、研究人员和临床医生拥有关键信息，可以规划早期干预措施，以减少 近端和远端负面精神结果，包括自杀死亡。

项目成果

Traumatic Brain Injury Classification Variability During the Afghanistan/Iraq Conflicts: Surveillance, Clinical, Research, and Policy Implications.

阿富汗/伊拉克冲突期间的创伤性脑损伤分类变异性：监测、临床、研究和政策影响。

• 发表时间: 2022-11-01
• 作者: Adams, Rachel Sayko;Hoover, Peter;Forster, Jeri E;Caban, Jesus;Brenner, Lisa A
• 通讯作者: Brenner, Lisa A

Racial and Ethnic Differences in Deaths by Suicide, Drug Overdose, and Opioid-Related Overdose in a National Sample of Military Members With Mild Traumatic Brain Injury, 1999-2019.

1999-2019 年全国轻度创伤性脑损伤军人样本中自杀、药物过量和阿片类药物相关过量死亡的种族和民族差异。

• 发表时间: 2023-03-01
• 作者: Bahraini, Nazanin;Adams, Rachel Sayko;Caban, Jesus;Kinney, Adam R;Forster, Jeri E;Hoffmire, Claire A;Monteith, Lindsey L;Brenner, Lisa A
• 通讯作者: Brenner, Lisa A