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Dobscha SK, Denneson LM, Kovas AE, Teo AR, Forsberg CW, Kaplan MS, Bossarte R, McFarland B. Correlates of Suicide among Veterans Treated in VA Primary Care. Paper presented at: Academy of Psychosomatic Medicine Annual Meeting; 2014 Nov 14; Fort Lauderdale, FL.
Background: Many people see primary care clinicians prior to suicide, yet little is known about the correlates of suicide among people who receive primary care prior to death. Our objective was to describe demographic, clinical, and psychosocial characteristics of a multi-state sample of veteran suicide decedents who received VA primary care prior to death, and compare these characteristics to those of a group of control patients. Methods: This retrospective case-control study used data from 41 VA facilities in 11 states. Data sources included VA administrative data, state death certificate data, and manual medical record review. Cases died by suicide in 2009 and had contact with VA primary care clinicians in the 6 months prior to suicide. Controls were matched 2:1 to cases based on age, sex, and having seen the same clinicians during the same time period. We used multivariate conditional logistic regression to examine associations between candidate predictor variables and suicide. Results: Two-hundred sixty-nine Veteran cases were matched to 538 controls. Rates of any mental health diagnosis (57% vs. 35%, p < .001), functional decline (29% vs. 12%, p < .001), sleep disturbance (47% vs. 31%, p < .001), endorsed suicidal ideation (32% vs. 6%, p < .001), relationship problem (23% vs. 8%, p < .001), isolation (21.9% vs. 7.2% p < .001), recently move (12% vs. 4%, p < .001), legal problems (8% vs. 2%, p < .001), financial problems (20% vs. 9%, p < .001), job/school problems (13% vs. 7%, p < .01) and grief/loss of a loved one (18% vs. 6%, p < .001) were greater in cases compared to controls. In the final model describing men (who comprised 97% of the sample), non-white race (OR = 0.51; 95% CI = 0.27-0.98) and VA service-connected disability (OR = 0.54; 95% CI = 0.36-0.80) were associated with decreased odds of suicide, while anxiety disorder other than post-traumatic stress disorder (OR = 3.52; 95% CI = 1.79-6.92), functional decline (OR = 2.60; 95% CI = 1.55-4.35), and endorsement of suicidal ideation (OR = 2.27; 95% CI = 1.07-4.83) were associated with greater odds of suicide. Discussion: We found that veterans seen in VA primary care who die by suicide have high rates of diagnosed psychiatric disorders, sleep problems, functional decline, expressed anger, suicidal ideation, and certain psychosocial stressors. Our findings differ somewhat from prior research by suggesting that anxiety disorder may be a relatively more important risk factor for suicide among veterans compared to major depression or substance use disorder. Conclusion: Assessment for anxiety disorders, functional decline, and suicidal ideation may be especially important for determining suicide risk in this population. Continued development of interventions that identify and address these conditions in primary care is indicated.
