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Online Identities ofPhysicians Bradley H. CrottyArash MostaghimiVineet M. Arora2013 год

Online Identities of Physicians
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Аннотация: ployed compared with those who did not deploy, this difference was not statistically significant (relative risk, 1.3; 95% CI, 1.0-1.7).The authors concluded that the increase in suicides paralleled an increase in mental disorder prevalence, mirroring our findings.Furthermore, the study did not control for covariates, particularly mental disorders.Suicidal behavior is extremely complex, and we agree with Drs Bryan and Clemans that other unmeasured factors may influence risk.It is important not to misinterpret our findings as suggesting that the conflicts in Iraq and Afghanistan have had no cumulative effect.Since 2005, suicide incidence in the Army increased just as sharply among soldiers who did not deploy as those who did.This corresponded to a steep increase in mental disorders in the military population overall, likely a product of intense wartime demands affecting soldiers throughout all phases of the deployment cycle.The aggregate research indicates that individuals who develop mental disorders following deployment or other military stressors unrelated to deployment will be at higher risk for suicide than individuals relatively less affected by such stressors.We agree that TBI is an important health concern requiring further study, along with other serious injuries and chronic illnesses associated with suicidal behaviors.5][6] With regard to potential moderators, stratification by age (<35 years and ≥35 years) did not change the results; deployment was not associated with increased risk for suicide in either age group.We took extensive steps to ensure valid results and address potential limitations of time-dependent covariates in the Cox models mentioned by Dr Larson and colleagues.This included adjusting for separation from the military and assessing deployment as both non-time-varying and timevarying covariates (in which individuals changed to a deployed status on the first day of deployment and remained in that category for the remainder of follow-up).The linkage of military and postmilitary data directly addresses potential biases of attrition from service.Most importantly, we conducted an entirely separate analysis using a nested casecontrol design with deployment as a static variable and found identical results.
Год издания: 2013
Авторы: Bradley H. Crotty, Arash Mostaghimi, Vineet M. Arora
Издательство: American Medical Association
Источник: JAMA
Ключевые слова: Social Media in Health Education, Web and Library Services, Health Literacy and Information Accessibility
Другие ссылки: JAMA (HTML)
Digital Access to Scholarship at Harvard (DASH) (Harvard University) (PDF)
Digital Access to Scholarship at Harvard (DASH) (Harvard University) (HTML)
PubMed (HTML)