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Health Services Research & Development

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2006 HSR&D National Meeting Abstract

3058 — Substance Abuse Related Mortality Among VA Psychiatric Patients

Author List:
Rosen CS (VA National Center for PTSD & VA HSR&D Center for Health Care Evaluation)
Kuhn ER (Sierra-Pacific MIRECC)
Greenbaum MA (Sierra-Pacific MIRECC & VA HSR&D Center for Health Care Evaluation)

To compare mortality and causes of death among male VA psychiatric patients with and without comorbid diagnosed substance use disorders.

This cohort study (N = 169,045) included all male Vietnam-era veterans between ages 40 and 59 who completed a VA outpatient mental health appointment and received a psychiatric diagnosis for mood, anxiety, PTSD, dementia, bipolar, or psychotic disorders during the last six months of FY 1998. Patient psychiatric and substance use diagnoses, demographics, and hospitalizations in the 12 months prior to the index visit were obtained from VA patient files. Seven-year mortality status was determined from VA benefits files (BIRLS). Cause of death information was obtained from the National Death Index for 3,833 individuals randomly selected from all patients who died within 4 years of the index visit. Binary logistic regression was used to compare 7-year all-cause mortality among psychiatric patients with and without alcohol and/or drug use diagnosis, after co-varying demographic factors, psychiatric diagnoses, and prior hospitalizations. Among the patients who had died, additional binary logistic regressions assessed whether alcohol and drug use diagnoses were associated with particular causes of death.

The seven-year mortality rate among dually-diagnosed patients (n = 51,787) was 16.7%, compared to 9.9% among psychiatric patients not diagnosed with substance use disorders (n = 117,258). Alcohol (OR = 1.5 to 1.7) and drug diagnoses (OR = 1.1 to 1.3) were still associated with increased mortality after controlling for covariates. Among patients who had died, alcohol use diagnoses were associated with a higher proportion of deaths from liver disease (OR = 2.5 to 6.4) and hepatitis (OR = 2.0 to 14.9), whereas drug use diagnoses were associated with more deaths from HIV (OR = 1.5 to 6.3) and accidental overdoses (OR = 1.8 to 4.8).

Substance use disorders greatly increase mortality risk among male VA psychiatric patients, especially from causes directly related to substance use.

These findings reconfirm the importance of providing effective substance abuse treatment to dually-diagnosed veterans in order to reduce morbidity and mortality in this at-risk population.

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