Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3057 — Higher Rates of Suicidality in Women Veterans With Depression and Comorbid PTSD

Author List:
Boggs CD (Durham VAMC VISN-6 MIRECC)
Strauss J (Durham VAMC, VISN-6 MIRECC, Duke University Medical Center)
Calhoun P (Durham VAMC HSR&D, VISN-6 MIRECC, Duke University Medical Center)
Roland J (Durham VAMC)
Marx C (Durham VAMC VISN-6 MIRECC, Duke University Medical Center)
Straits-Troster K (Durham VAMC VISN-6 MIRECC)
Butterfield MI (Durham VAMC HSR&D, VISN-6 MIRECC, Duke University Medical Center)

Objectives:
The VA and DOD have jointly developed evidence-based Clinical Practice Guidelines for depression. These guidelines endorse clinical assessment of co-morbid PTSD, substance use disorders, and suicidality among veterans with depression. As PTSD and depression are among the most common mental disorders in women, and as both confer risk for suicidality, we sought to determine if co-morbid PTSD is associated with increased risk for suicidality in women veterans receiving outpatient treatment for depression.

Methods:
A consecutive sample of women veterans with depression (N=150), recruited from the Durham VA Comprehensive Women’s Health Center, were assessed for co-morbid PTSD, substance use disorders and suicidality. Depression diagnosis, a study inclusion criterion, was based on psychiatric record review and DSM-IV diagnostic criteria. Co-morbid PTSD diagnosis was determined by applying DSM-IV criteria to participants’ responses on the 17-item PTSD Checklist (PCL). Co-morbid substance use disorders were assessed with the Dartmouth Assessment of Lifestyle Inventory (DALI). Suicidality was determined using the Duke Mental Health Inventory, which included an assessment of recent suicidal ideation.

Results:
Ninety-five patients (63%) met criteria for PTSD based upon the PCL. Those with PTSD did not differ in age, race, marital status, education, alcohol and drug use compared to those without PTSD. Those with comorbid PTSD were more likely to endorse suicidal ideation (41% vs. 24%, Chi Square=4.36, p<.05). In an adjusted logistic regression accounting for age, race, substance use, and trauma history, PTSD severity was significantly associated with self-reported suicidal ideation within the previous six months (OR=1.05, 95%CI 1.21-1.79, p=.001).

Implications:
Women veterans with depression and comorbid PTSD are more likely to report suicidal ideation than those without PTSD, even after adjusting for substance use, a known risk factor for suidicality. Women veterans with depression and comorbid PTSD may be at heightened risk for suicide.

Impacts:
This research supports the VA/DOD Clinical Practice Guidelines and underscores the necessity of routinely screening woman veterans with depression for PTSD and suicidality.