摘要：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. Methods. We gathered 2010 Behavioral Risk Factor Surveillance System data from 5 states that asked about past-year suicidal ideation. Military service was defined as current or former active-duty service or National Guard or Reserves service. We stratified analyses into 18 to 39 years, 40 to 64 years, and 65 years and older age groups and used multiple logistic regression analyses, adjusted for demographic confounders, to discern the association of military service history with past-year suicidal ideation and past-30-days mental distress. Results. Among the 26 736 respondents, 13.1% indicated military service history. After adjusting for several confounders, we found military history status among those aged 40 to 64 years was associated with both past-year suicidal ideation and past-30-days mental distress. We found no significant associations among the younger or older age groups. Conclusions. Differences in suicidal ideation between military and nonmilitary individuals may occur in midlife. Future research should examine the possibility of cohort effects, service era effects, or both. In the United States, suicide has over the past decade become the 10th leading cause of death. 1 Since 2005, suicide rates among US active-duty service members have seen unprecedented increases, 2 and US veterans are estimated to make up about 20% of individuals who die from suicide. 3 Identifying, assessing, and engaging US service members and veterans who may have risk for suicide are major priorities for the clinicians, public health professionals, and organizations serving veterans and their families. 2,4 In examining suicidality among service members and veterans, a preponderance of studies have focused on those already engaged in health care settings within the US Department of Defense or Veterans Health Administration environments (i.e., clinical populations). 5–8 Population-based investigations of suicide risk among general samples of service members and veterans are scant, predominately reporting overall rates of suicide mortality. 9–16 Research about whether US military service itself is associated independently with risk for suicide remains equivocal. 12,17 Additionally, it is unclear whether phenomena related to yet distinct from suicide, such as suicidal ideation, may be elevated among service members and veterans. Studies among service members and veterans have identified varying prevalence of suicidal ideation, ranging from 6.5% to 45.9% in clinical samples 18–22 and from 2.3% to 21.2% in nonclinical samples. 23–28 However, most of this research has used non–probability-based sampling methods and lacked comparison groups of people without military experience. For example, using data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS), Bossarte et al. (2012) found that 3.8% of veterans reported suicidal ideation in the past 12 months. 28 Although this estimate resembles the national estimate for suicidal ideation among adults (3.7%), 29 the data were from only 2 states (Nebraska and Tennessee) and lacked a comparison group without military experience. Perhaps the clearest current investigation of suicidal ideation among a nonclinical, probability-based sample of people with and without military service history comes from the National Survey of Drug Use and Health (NSDUH). White et al. 30 analyzed data for men from the 2008 NSDUH data set and stratified the analysis by age groups of 18 to 25 years, 26 to 35 years, and 36 years and older. They found no differences in prevalence of past-12-month suicidal ideation between men who had ever served on active duty (3.0%) and men who had never served on active duty (3.7%). Although they found no difference in suicidal ideation between military service history status within age groups, the age groupings used by White et al. were constructed in a way that may not have been sensitive to a key shift in suicide risk in the general US population: the increase of suicide among people in midlife (approximately aged 40–64 years). 31–33 With the increasing focus on suicide among current and former military populations, population-based data for examining differences in suicidal ideation between people with and without military service history are remarkably scarce. The few studies that have managed to make these comparisons have limitations, and further research is needed regarding the prevalence of suicidal behaviors among those who have served in the military and the associations between suicide risk and characteristics that may be unique to members of this group. Using data from the BRFSS, which gathers population-based health risk information from each US state, we compared the prevalence of past-year suicidal ideation and past-30-days mental distress among a large probability-based sample of US adults by history of military service. Furthermore, because suicide risk varies by age in the general US population, 29,34 we also examined whether prevalence of suicidal ideation and mental distress differed on the basis of the age categories (18–39 years, 40–64 years, ≥ 65 years) that were used in the detection of the midlife increase in suicide among US adults. 31
