Substance Abuse is Strongest Predictor of Suicide among Veterans with Depression
Suicide is a major but potentially preventable public health problem, and depression is a recognized major risk factor. This study was an analysis designed to derive an empirically-based set of interactions related to rates of suicide in a national sample of VA patients diagnosed with depression. Using data from a previous study, investigators identified 887,859 Veterans treated for depression between 4/99 and 9/04 in order to produce subgroups of patients at differing levels of risk for suicide. Subgroups were identified by a combination of factors that included: co-occurring substance use disorder (SUD), gender, ethnicity, diagnosis of PTSD, and VA psychiatric hospitalization in the prior year.
Findings show that among Veterans with depression those at highest risk for suicide have the combined risk factors of a substance use disorder, non-African American race, and a psychiatric inpatient stay in the past 12 months. Substance use disorder was also identified as the strongest single risk factor for suicide. Among Veterans without a substance use disorder, gender was the strongest predictor of suicide risk - rates were significantly higher for men than for women. Ethnicity also was related to suicide risk in this group. African American Veterans without an SUD were less likely to die by suicide compared to non-African American Veterans. The authors suggest that providers treating patients with these characteristics should be aware of these risks and consider target strategies to screen for current suicidal ideation.
Ilgen M, Downing K, Zivin K, et al. Identifying Subgroups of Patients with Depression Who are at High Risk for Suicide. Journal of Clinical Psychiatry November 2009;70(11):1495-1500.
This study was partly funded by HSR&D. All authors are part of the VA Serious Mental Illness Treatment Research and Evaluation Center in Ann Arbor, MI.