Importance The COVID-19 pandemic has raised considerable concerns about increased risk for suicidal behavior among US military veterans, who already had elevated rates of suicide before the pandemic. Objective To examine longitudinal changes in suicidal behavior from before the COVID-19 pandemic to nearly 10 months into the pandemic and identify risk factors and COVID-related variables associated with new-onset suicide ideation (SI). Design, Setting, and Participants This population-based prospective cohort study used data from the first and second wave of the National Health and Resilience in Veterans Study, conducted from November 18, 2019, to December 19, 2020. Median dates of data collection for the prepandemic and peripandemic assessments were November 21, 2019, and November 14, 2020, nearly 10 months after the start of the COVID-19 public health emergency in the US. A total of 3078 US military veterans aged 22 to 99 years were included in the study. Main Outcomes and Measures Past-year SI and suicide attempts. Results In this cohort study of 3078 US veterans (mean [SD] age, 63.2 [14.7] years; 91.6% men; 79.3% non-Hispanic White veterans, 10.3% non-Hispanic Black veterans, and 6.0% Hispanic veterans), 233 (7.8%) reported past-year SI, and 8 (0.3%) reported suicide attempts at the peripandemic assessment. Past-year SI decreased from 10.6% prepandemic (95% CI, 9.6%-11.8%) to 7.8% peripandemic (95% CI, 6.9%-8.8%). A total of 82 veterans (2.6%) developed new-onset SI over the follow-up period. After adjusting for sociodemographic and military characteristics, the strongest risk factors and COVID-19-related variables for new-onset SI were low social support (odds ratio [OR], 2.77; 95% CI, 1.46-5.28), suicide attempt history (OR, 6.31; 95% CI, 2.71-14.67), lifetime posttraumatic stress disorder and/or depression (OR, 2.25; 95% CI, 1.16-4.35), past-year alcohol use disorder severity (OR, 1.06; 95% CI, 1.01-1.12), COVID-19 infection (OR, 2.41; 95% CI, 1.41-5.01), and worsening of social relationships during the pandemic (OR, 1.47; 95% CI, 1.16-1.88). Conclusions and Relevance The results of this cohort study suggest that despite grim forecasts that the COVID-19 pandemic would exacerbate suicidality among US military veterans, the rate of SI decreased at the population level nearly 10 months into the pandemic. Veterans who were infected with COVID-19 were more than twice as likely to report SI, which suggests the need for future research to examine the potential link between COVID-19 infection and suicidal behavior.

中文翻译：

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COVID-19 大流行期间美国退伍军人自杀行为的流行和趋势。

重要性 COVID-19 大流行引起了人们对美国退伍军人自杀行为风险增加的极大担忧，他们在大流行之前的自杀率已经升高。目的 研究从 COVID-19 大流行之前到大流行近 10 个月期间自杀行为的纵向变化，并确定与新发自杀意念 (SI) 相关的风险因素和 COVID 相关变量。设计、设置和参与者这项基于人群的前瞻性队列研究使用了 2019 年 11 月 18 日至 2020 年 12 月 19 日进行的第一波和第二波国家退伍军人健康和复原力研究的数据。大流行前和大流行期间的评估分别为 2019 年 11 月 21 日和 2020 年 11 月 14 日，在美国发生 COVID-19 突发公共卫生事件近 10 个月后。共有 3078 名 22 至 99 岁的美国退伍军人被纳入研究。主要结果和措施 过去一年的 SI 和自杀未遂。结果 在这项对 3078 名美国退伍军人（平均 [SD] 年龄，63.2 [14.7] 岁；91.6% 男性；79.3% 非西班牙裔白人退伍军人，10.3% 非西班牙裔黑人退伍军人和 6.0% 西班牙裔退伍军人）的队列研究中，233 (7.8%) 报告了过去一年的 SI，8 人 (0.3%) 在大流行评估中报告了自杀企图。过去一年的 SI 从流行前的 10.6%（95% CI，9.6%-11.8%）下降到流行前的 7.8%（95% CI，6.9%-8.8%）。在随访期间，共有 82 名退伍军人 (2.6%) 出现了新发 SI。在调整了社会人口和军事特征后，新发 SI 的最强风险因素和 COVID-19 相关变量是低社会支持（优势比 [OR]，2.77；95% CI，1.46-5.28），自杀未遂史（OR，6.31；95% CI， 2.71-14.67），终生创伤后应激障碍和/或抑郁症（OR，2.25；95% CI，1.16-4.35），过去一年酒精使用障碍严重程度（OR，1.06；95% CI，1.01-1.12），COVID- 19 感染（OR，2.41；95% CI，1.41-5.01）和大流行期间社会关系恶化（OR，1.47；95% CI，1.16-1.88）。结论和相关性 这项队列研究的结果表明，尽管严峻的预测是 COVID-19 大流行会加剧美国退伍军人的自杀率，但在大流行近 10 个月后，SI 的发生率在人口水平上有所下降。感染 COVID-19 的退伍军人报告 SI 的可能性是其两倍多，