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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

1067 — Last Contact with the VA Health Care System and Suicide among Veterans in Depression Treatment

Smith EG (Bedford COE (CHQOER); University of Massachusetts), Craig T , Ganoczy D (Ann Arbor COE/SMITREC; University of Michigan), Walters H (Ann Arbor COE/SMITREC; University of Michigan), Valenstein M (Ann Arbor COE/SMITREC; University of Michigan)

Objectives:
We assessed the time interval between the last VA health services visit and suicide among patients in depression treatment, and what patient demographic, clinical, and treatment characteristics were associated with this time interval.

Methods:
Using a comprehensive assessment of suicide among veterans in depression treatment between April 1, 1999 and September 30, 2004, we determined the time from last visit to completed suicide. In bivariate analyses, we assessed the association between patient characteristics and four time periods from last visit to the time of suicide (0-7 days; 8-30 days; 31-90 days; and 91+ days).

Results:
Of 1,858 veterans in depression treatment who completed suicide during the study period, more than half (55%) completed suicide within 30 days of their last clinical visit, with more than one-quarter (27%) completing suicide within 7 days. For most veterans completing suicide, their last visit was to a non-psychiatric clinician (60%), although most of these veterans had received prior psychiatric care (71%). Characteristics associated with completed suicide within 30 days of last visit included: older age; diagnosis of PTSD, other anxiety disorder or major depression; > 2 psychiatric diagnoses; a Charlson comorbidity score of ?2; and a recent psychiatric inpatient admission. (28% of veterans completing suicide within 30 days of last visit had had a psychiatric inpatient admission within the past year, usually within 3 months of suicide). Most veterans (65%) who completed suicide within 30 days were receiving antidepressant medication at the time of suicide.

Implications:
The majority of suicides among VA patients in depression treatment occur within 30 days of their last visit and most were receiving antidepressants. Particularly high risk groups for suicide occurring shortly after a treatment visit include those with recent psychiatric admissions and those with significant psychiatric and/or medical comorbidity.

Impacts:
(1) Ongoing assessment of suicide risk is vital for depressed patients in both psychiatric and non-psychiatric treatment. (2) It is crucial to identify effective methods of assessment and intervention, given most patients completing suicide during depression treatment see a provider within the previous 30 days.


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