RESUMEN
STUDY OBJECTIVES: Suicide is a top public health priority, and U.S. Veterans are recognized to be at particularly elevated risk. Sleep disturbances are an independent risk factor for suicide; recent empirical data suggest that nocturnal wakefulness may be a key mechanism underlying this association. Given higher rates of sleep disturbances among U.S. Veterans compared with civilians, we examined associations between nocturnal wakefulness and timing of death by suicide in U.S. Veterans and civilians to determine whether temporal suicide patterns differed. METHODS: The American Time Use Survey and the National Violent Death Reporting System were analyzed (2006-2015) to determine whether sleep and temporal suicide patterns differed between age-stratified groups (18-39, 40-64, and ≥65) of U.S. Veterans and civilians. Observed temporal suicide patterns were reported and standardized incidence ratios (SIRs) calculated to compare the percentage of suicides observed with those expected, given the proportion of the population awake, across clock hours. RESULTS: The raw proportion of Veteran suicides peaks between the hours of 1000-1200; however, the peak prevalence of suicide after accounting for the population awake is between 0000 and 0300 hr (p < .00001, Ï = .88). The highest SIR was at midnight; U.S. Veterans were eight times more likely to die by suicide than expected given the population awake (SIR = 8.17; 95% CI = 7.45-8.94). CONCLUSIONS: Nocturnal wakefulness is associated with increased risk for suicide in U.S. Veterans. Overall patterns of observed suicides by clock hour were similar between U.S. Veterans and civilians. However, Veteran-specific SIRs suggest differences in magnitude of risk by clock hour across age groups. Future research examining female and Post-9/11 U.S. Veterans is warranted.
Asunto(s)
Suicidio/estadística & datos numéricos , Veteranos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Salud Pública , Factores de Riesgo , Trastornos del Inicio y del Mantenimiento del Sueño/fisiopatología , Trastornos del Sueño-Vigilia/fisiopatología , Encuestas y Cuestionarios , Factores de Tiempo , Estados Unidos , Vigilia/fisiología , Adulto JovenRESUMEN
BACKGROUND: Although Veterans utilize complementary and alternative medicine (CAM) at rates comparable with civilians, little is known about Veterans' attitudes and beliefs toward CAM. Measures to increase such knowledge may help to identify treatment preferences, particularly among those with signature conditions from the recent conflicts [ie, traumatic brain injury (TBI), posttraumatic stress disorder (PTSD)]. OBJECTIVE: This exploratory study aimed to: (1) determine the factors of the Complementary, Alternative, and Conventional Medicine Attitudes Scale (CACMAS); and to utilize the resulting factors to describe (2) attitudes and beliefs toward CAM; (3) their association with TBI, PTSD, and history of self-directed violence. Patterns of CAM use were also obtained. RESEARCH DESIGN: Factor analysis. Observational study. SUBJECTS: Participants were 97 Veterans seeking care at a Mountain State Veterans Affairs Medical Center. METHODS: Participants completed the CACMAS, clinical interviews, and self-report measures during a single visit. RESULTS: CACMAS factors identified were: acceptability of (1) CAM and (2) conventional medicine; (3) mind-body integration; and (4) belief in CAM. Acceptability of CAM was significantly associated with history of mild TBI (mTBI) or PTSD symptom severity. Veterans endorsed a wide range of CAM use. CONCLUSIONS: Veterans in this sample were open to CAM and conventional medicine, believed in CAM, and believed that treatments should incorporate the mind and body. Veterans with a history of mTBI or PTSD symptoms may be more accepting of CAM. Understanding Veterans' beliefs and attitudes regarding CAM may help providers deliver patient-centered treatments, particularly among those with conditions for which evidence-based interventions are limited (eg, mTBI).
Asunto(s)
Terapias Complementarias/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Veteranos/psicología , Análisis Factorial , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Autoinforme , Estados UnidosRESUMEN
OBJECTIVE: To determine whether a positive screen on the Traumatic Brain Injury-4 (TBI-4) can be used to identify veterans who use more inpatient and outpatient mental health services. DESIGN: Validation cohort. SETTING: Medical center. PARTICIPANTS: Individuals seeking Veterans Health Administration mental health services (N=1493). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: One year of inpatient and outpatient mental health utilization data after the TBI-4 screen date. RESULTS: In the year postmental health intake, those who answered positively to any of the 4 TBI-4 screening questions (criterion 1) or question 2 (criterion 2; ever having been knocked out) had significantly more psychiatric hospitalizations than those who met neither criterion. Those who were positive by criterion 2 also had significantly fewer outpatient mental health contacts. CONCLUSIONS: Veterans screening positive for history of traumatic brain injury on the TBI-4 had more hospital stays in the year postmental health intake. Those who reported having been knocked out also had fewer outpatient mental health visits. These findings may suggest an overall relation in this population between greater needs for mental health care and likelihood of prior injury. For those with a history of loss of consciousness, the reduced use of outpatient care may reflect greater problems engaging in treatment or with preventive aspects of the health care system during non-crisis periods. Using a screener (eg, the TBI-4) could facilitate identification of veterans who might benefit from targeted and intensive outpatient interventions to avoid frequent inpatient psychiatric hospitalization.