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Health Services Research & Development

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2009 HSR&D National Meeting Abstract

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National Meeting 2009

3035 — Suicidal Ideation among HIV-Infected and Uninfected Veterans in Care

Goulet JL (REAP West Haven/VA Connecticut Healthcare System), Crystal S (Institute for Health, Rutgers University), Day N (Department of Psychiatry, University of Pittsburgh School of Medicine), Fultz SL (Office of Public Health and Environmental Hazards, VHA, Washington, DC), Gibert C (VAMC, Washington, DC), Kerns RD (REAP West Haven/VA Connecticut Healthcare System), Peck RW (VAMC, Washington, DC), Justice AC (VA Connecticut Healthcare System)

Objectives:
Suicidal ideation (SI) is a risk factor for suicidal behavior, and may have additional deleterious effects on veteran’s health. We examined SI prevalence, correlates, persistence, and outcomes in a sample of HIV-infected and uninfected veterans.

Methods:
We analyzed self-report and administrative data on 5,998 participants from Veterans Aging Cohort Study (VACS), a prospective multisite observational study of HIV-positive and HIV-negative veterans in care at eight VA facilities. SI was defined as an affirmative response to item 9 of the Patient Health Questionnaire (PHQ-9), assessed for the preceding 4 weeks. We examined associations with SI and: demographics; health risk factors (e.g., smoking, obesity); Short Form-12 (SF-12) pain and general health items; psychiatric and medical conditions (e.g., major depressive disorder [MDD], PTSD, alcohol, and HIV); period of service (e.g. Vietnam); and one year all-cause mortality. We also examined the persistence of SI at one year follow-up survey. Multivariable analyses used logistic and Cox regression.

Results:
The sample was 95% male, the mean age was 50 years, 28% were white, and 48% served in the Vietnam era. Overall, 962 (16%) participants reported SI, of whom 159 (17%) reported it ‘nearly every day’. In the multivariable logistic model, SI was associated with: younger age, white race, male gender, MDD, PTSD, drug disorder, smoking, pain, self-reported health, and HIV status (p < 0.05 for all). At one year follow-up, 53% of patients with baseline SI continued to report SI. Correlates of persistence were similar to correlates of baseline SI. One year all-cause mortality was 3.2% among veterans with SI versus 1.8% among those without (p < 0.05). In multivariable Cox models, SI ‘nearly every day’ was associated with a higher mortality risk (hazard ratio = 2.42, 95% CI = 1.12-5.24).

Implications:
SI is highly prevalent, associated with health risk factors, and psychiatric and medical conditions. SI is persistent, and is associated with all-cause mortality.

Impacts:
Compared to non-VA samples, the prevalence of SI is extremely high (e.g., lifetime prevalence in the National Comorbidity Survey was 8.7%). Our findings underscore the need to provide frequent SI screening, outreach, and services to veterans, and highlight subgroups at elevated risk that warrant special attention in screening efforts.


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