Suchergebnisse

Purpose: The aim of this investigation was to document the prevalence and correlates of refusing to answer a US federal health survey item about firearms in the household. Design: The cross-sectional analysis was conducted with 2004 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) survey data from Texas, Oregon, Idaho, California, Kansas, and Utah states whose surveys included items about firearms in the household. Participants: Probability-based samples of adults over the age of 18 (n = 34 488 in 2017 BRFSS; n = 33 136 in 2004 BRFSS). Measures: Dichotomized measure of whether respondents answered versus refused to answer "Are any firearms now kept in or around your home?" Analysis: Weighted multiple logistic regression was used to assess how sociodemographic and health-related characteristics were associated with item refusal. Results: Approximately 1.8% (95% CI: 1.6-2.1) of respondents in 2004 and 3.9% (95% CI: 3.4-4.5) of respondents in 2017 sample refused the firearms item ( P < .01). Men were more likely than women (2004: adjusted odds ratio [aOR] = 1.81, 95% CI: 1.24-2.62; 2017: aOR = 1.60, 95% CI = 1.17-2.18) and Latino/a respondents were less likely than white respondents (2004: aOR = 0.24, 95% CI: 0.10-0.60; 2017: aOR = 0.21, 95% CI: 0.13-0.34) to refuse the firearms question. In 2004, refusal was more likely among older than younger respondents, but in 2017, age was not associated with refusal. Conclusions: Refusal to firearm-related survey items along sociodemographic characteristics warrants further research. Community-informed strategies (eg, focus groups, cognitive testing, in-depth interviews) could improve the context and wording of firearm-related items to maximize response to these items in public health surveys.

Objectives. We examined the association of military service history with past-year suicidal ideation and past-30-days mental distress in a probability-based sample of adults.

OBJECTIVES: Although lesbian, gay, bisexual, and transgender (LGBT) people have a higher prevalence of reporting a lifetime suicide attempt than non-LGBT people, suicide prevention research on access to lethal means (eg, firearms) among LGBT people is limited. Our study examined (1) the presence of firearms in the home and (2) among respondents with firearms in the home, the storage of firearms as stored unloaded, stored as loaded and locked, or stored as loaded and unlocked. METHODS: We used data from the 2017 Behavioral Risk Factor Surveillance System surveys from California and Texas (N = 11 694), which were the only states to include items about both sexual orientation and gender identity and the status of firearms in the home. We used logistic regression analysis to assess the association of sexual orientation and gender identity with having firearms in the home while accounting for sociodemographic characteristics and survey state. All analyses were weighted to account for the complex sampling design. RESULTS: Approximately 4.2% of the sample identified as lesbian, gay, and bisexual (LGB). About 18.2% of LGB people reported firearms in the home compared with 29.9% of their heterosexual peers. After adjusting for sex, age, race/ethnicity, educational attainment, and military veteran status, LGB respondents had significantly lower odds of reporting firearms in the home than their heterosexual peers (adjusted odds ratio = 0.47; 95% CI, 0.27-0.84). Among respondents with firearms in the home, firearm storage did not differ by sexual orientation. CONCLUSIONS: Further research is needed to examine whether lower odds of firearms in the home are protective against suicide deaths among LGB populations.

IMPORTANCE: Adverse childhood experiences (ACE) are associated with several adulthood health problems, such as self-directed violence. For some individuals, enlistment in the military may be an instrumental act to escape adverse household environments, however prevalence of ACE among persons with military service histories has not been documented in the U.S. using population-based data. OBJECTIVE: To compare the prevalence of ACE among individuals with and without histories of military service. We hypothesized that ACE differences between military and non-military groups will be more pronounced during the era when the military became all-volunteer (enlisted on or after 1973) versus the draft era (pre-1973). DESIGN, SETTING & PARTICIPANTS: Data are from the 2010 Behavioral Risk Factor Surveillance System. Computer-assisted telephone interviews were conducted with population-based samples of non-institutionalized U.S. adults during January-December 2010. Analyses were limited to respondents who received the ACE module (n=60,598). Participants were categorized by military service history and whether a respondent was 18 years of age in 1973. MAIN OUTCOMES: Military service history was defined by active duty service, veteran status, or training for the Reserves or National Guard. The ACE inventory assessed 11 negative experiences before the age of 18. Weighted chi-square and multiple logistic regression analyses were used to examine differences in ACE by military service history, era of service, and gender. RESULTS: Any difference in prevalence of ACE showed greater odds for those with military experience. In the All-volunteer Era, men with military service had higher prevalence of all eleven ACE items than men without military service; in the Draft Era there were only two differences. Notably, in the All-volunteer Era, men with military service had twice the odds of reporting forced sex before the age of 18 (OR=2.19, 95%CI: 1.34–3.57) compared to men without military service. Fewer differences were observed ...

The aim of this study was to investigate sexual orientation differences in gun ownership and gun safety beliefs among U.S. adults. We used information from the General Social Survey (2010–2016) to assess presence of guns in the household, personal gun ownership, and endorsement of a gun safety law among sexual minority (n = 195) versus heterosexual (n = 4359) respondents. Methods employed multivariate logistic regression analyses adjusted for confounding including gender, age, race/ethnicity, education level, size of household, urbanicity, military veteran status, and political views. Gay/bisexual men were more likely to endorse a gun safety law (adjusted odds ratio [aOR] = 3.24, 95% confidence interval [CI] = 1.79–5.88) and less likely to report guns in the household (aOR = 0.34, 95% CI = 0.18–0.65) than heterosexual men. In contrast, lesbian/bisexual and heterosexual women similarly endorsed a gun safety law and reported household guns. However, among women reporting a household gun, lesbian/bisexual women were more likely to be the personal gun owner (aOR = 3.97, 95% CI = 1.43–11.03). Attitudes toward a gun safety law and gun ownership differ by sexual orientation, but patterns vary by gender. We recommend that clinicians inquire about gun ownership and gun storage practices with both heterosexual and sexual minority patients.

Adverse childhood experiences (ACEs) are robustly associated with physical and mental health problems over the lifespan. Relatively limited research has examined the breadth of ACEs among military veteran populations, for whom ACEs may be premilitary traumas associated with suicidal ideation and attempt. Using data from the Comparative Health Assessment Interview Research Study, a large national survey sponsored by the US Department of Veterans Affairs, this investigation examined the prevalence of 22 self-reported potentially traumatic experiences before the age of 18 (i.e., ACEs) among veterans and nonveterans and estimated the association of ACEs with suicidal ideation and attempt at age 18 or older. All analyses were weighted to account for complex sampling design and stratified by gender. The study sample included 9,571 veteran men, 3,143 nonveteran men, 5,543 veteran women, and 1,364 nonveteran women. Veteran men reported greater average frequency of ACEs than nonveteran men (2.7 ACEs vs. 2.3 ACEs, respectively, p6 ACEs compared to 7.3% of nonveteran men (p6 ACEs (14.9% vs. 8.6%, respectively, p6 ACEs (aOR=4.20, 95%CI=2.72-6.49); for veteran women, the strongest correlate was suicidal ideation or attempt prior to age 18 (aOR=5.37, 95%CI=4.11-7.03). Suicide prevention research, policy, and practice should address ACEs among veterans as salient premilitary risk factors.

Objectives: Suicide risk is elevated in lesbian, gay, bisexual, and transgender (LGBT) individuals. Limited data on LGBT status in healthcare systems hinder our understanding of this risk. This study used natural language processing to extract LGBT status and a deep neural network (DNN) to examine suicidal death risk factors among US Veterans.Methods: Data on 8.8 million veterans with visits between 2010 and 2017 was used. A case-control study was performed, and suicide death risk was analyzed by a DNN. Feature impacts and interactions on the outcome were evaluated.Results: The crude suicide mortality rate was higher in LGBT patients. However, after adjusting for over 200 risk and protective factors, known LGBT status was associated with reduced risk compared to LGBT-Unknown status. Among LGBT patients, black, female, married, and older Veterans have a higher risk, while Veterans of various religions have a lower risk.Conclusion: Our results suggest that disclosed LGBT status is not directly associated with an increase suicide death risk, however, other factors (e.g., depression and anxiety caused by stigma) are associated with suicide death risks.

Transgender persons have high rates of alcohol and other drug use disorders (AUD and DUD, respectively) and commonly experience social and economic stressors that may compound risk for adverse substance-related outcomes. National VA electronic health record data were extracted for all outpatients in each facility with documented alcohol screening 10/1/09–7/31/17. We describe the prevalence of eight individual-level social and economic stressors (barriers to accessing care, economic hardship, housing instability, homelessness, social and family problems, legal problems, military sexual trauma, and other victimization) among transgender patients with and without AUD and DUD (alone and in combination), overall and compared to cisgender patients in a national sample of VA outpatients. Among 8,872,793 patients, 8619 (0.1%) were transgender; the prevalence of AUD, DUD, and both was 8.6%, 7.2%, and 3.1% among transgender patients and 6.1%, 3.9%, and 1.7% among cisgender patients, respectively. Among all patients, prevalence of stressors was higher among those with AUD, DUD, or both, relative to those with neither. Within each of these groups, prevalence was 2–3 times higher among transgender compared to cisgender patients. For instance, prevalence of housing instability for transgender vs. cisgender patients with AUD, DUD, and both was: 40.8% vs 24.1%, 45.8% vs. 36.6%, and 57.4% vs. 47.0%, respectively. (all p-values <0.001). Social and economic stressors were prevalent among patients with AUD, DUD, or both, and the experience of these disorders and social and economic stressors was more common among transgender than cisgender patients in all groups. Further research regarding experiences of transgender persons and influences of stressors on risk of AUD and DUD, substance-related outcomes, and treatment uptake are needed. Routine screening for social and economic stressors among patients with substance use disorders (SUDs) could improve equitable substance-related care and outcomes. Treatment of SUDs among all ...

BACKGROUND: Health care systems struggle to identify risk factors for suicide. Adverse social determinants of health (SDH) are strong predictors of suicide risk, but most electronic health records (EHR) do not include SDH data. OBJECTIVE: To determine the prevalence of SDH documentation in the EHR and how SDH are associated with suicide ideation and attempt. DESIGN: This cross-sectional analysis included EHR data spanning October 1, 2015–September 30, 2016, from the Veterans Integrated Service Network Region 4. PARTICIPANTS: The study included all patients with at least one inpatient or outpatient visit (n = 293,872). MAIN MEASUREMENTS: Adverse SDH, operationalized using Veterans Health Administration (VHA) coding for services and International Statistical Classification of Diseases and Related Health Problems (ICD)-10 codes, encompassed seven types (violence, housing instability, financial/employment problems, legal problems, familial/social problems, lack of access to care/transportation, and nonspecific psychosocial needs). We defined suicide morbidity by ICD-10 codes and data from the VHA's Suicide Prevention Applications Network. Logistic regression assessed associations of SDH with suicide morbidity, adjusting for socio-demographics and mental health diagnoses (e.g., major depression). Statistical significance was assessed with p < .01. KEY RESULTS: Overall, 16.4% of patients had at least one adverse SDH indicator. Adverse SDH exhibited dose-response-like associations with suicidal ideation and suicide attempt: each additional adverse SDH increased odds of suicidal ideation by 67% (AOR = 1.67, 99%CI = 1.60–1.75; p < .01) and suicide attempt by 49% (AOR = 1.49, 99%CI = 1.33–1.68; p < .01). Independently, each adverse SDH had strong effect sizes, ranging from 1.86 (99%CI = 1.58–2.19; p < .01) for legal issues to 3.10 (99%CI = 2.74–3.50; p < .01) for non-specific psychosocial needs in models assessing suicidal ideation and from 1.58 (99%CI = 1.10–2.27; p < .01) for employment/financial ...