Most VA Patients with Substance Use Disorders Who Die from Suicide Use Violent Means
Within the United States, suicide is the fourth leading cause of death in adults 18 to 65 years of age, and suicide is predominantly carried out by violent methods, with firearms accounting for 53% of all suicides. Many would consider patients with substance use disorders (SUDs) to be at particular risk for non-violent suicide through overdose, given the potential availability of lethal doses of drugs “on hand” during periods of distress. This observational study examined the numbers of violent (e.g., firearms, hanging) and non-violent (e.g., drug overdose, poison) suicide among Veterans with SUDs treated within the VA healthcare system, as well as the demographic and clinical risk factors associated with suicide by violent and non-violent means. Using VA data and data from the National Death Index, investigators identified 854 Veterans who died by suicide between FY02 through 2006 and a random sample of 4,228 Veterans who did not die by suicide during the same time period. In both groups, Veterans had been diagnosed at least twice with one or more SUDs within five years prior to FY02.
Findings show that most VA patients with SUDs who died from suicide used violent means (70%, n=600), and the majority were carried out with firearms. No specific SUD was associated with increased risks of violent suicide, but several SUD diagnoses (e.g., cocaine use and opiate use) were associated with a higher risk of non-violent suicide. Alcohol use was associated with a lower likelihood of non-violent suicide. While many psychiatric disorders (e.g., major depression, PTSD, schizophrenia) were associated with increased risk of both violent and non-violent suicide, the strength of the association between the disorder and type of suicide was greater for non-violent than violent suicide. The authors suggest that by linking data on risk factors to information about the specific methods used, future interventions designed to decrease access to lethal means could be tailored to focus on those at greatest risk of dying by specific means.
Ilgen M, Conner K, Valenstein M, Austin K, and Blow F. Violent and non-violent suicide in Veterans with substance use disorders. Journal of Studies on Alcohol & Drugs July 2010;71(4):473-79.
This study was partly funded by HSR&D (MRP 05-137). All authors except Dr. Conner are part of HSR&D’s Center for Clinical Management Research in Ann Arbor, MI.