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2009 HSR&D National Meeting Abstract

National Meeting 2009

1022 — Mental Illness, Substance Use Disorders and Mortality among Veteran Clinic Users with Spinal Cord Injury

Findley P (REAP, E. Orange), Banerjea R (REAP, E. Orange), Findley T (REAP, E. Orange), Sambamoorthi U (REAP, E. Orange)

To estimate the mortality rates among veteran clinic users with spinal cord injuries (SCI) and examine variations in mortality by mental illness (MI) and substance use disorders (SUD) after controlling for demographic, socioeconomic, SCI severity and duration of injury, and chronic physical illnesses.

Longitudinal analysis of the SCI registry, Veterans Health Administration (VHA) administrative data, and Medicare claims for fiscal years 1999 through 2004. SCI was identified through the SCI registry; individual MIs (anxiety, bipolar and depressive disorders, psychoses, post-traumatic stress disorder, and schizophrenia) and categories of SUD (tobacco, alcohol and/or drug use) were identified through ICD-9-CM codes. Presence of diabetes was ascertained by merging this data with the Diabetes Epidemiologic Cohort diabetes cohort. Other physical conditions were identified using ICD-9-CM codes. Population studied: VHA users (N = 9,035) with SCI and followed through the end of fiscal year 2004. Mortality status was determined through the Beneficiary Identification Records Locator Subsystem (BIRLS) and VHA inpatient and outpatient files.

Overall, 80% of VHA users with SCI survived during the study period. Nearly 25% with MI and 25% with SUD died between 1999 and 2004. Depression and anxiety disorders were the most common types of MI. Hazards ratios indicated that SUD (1.49) and MI (1.32) increased mortality even after controlling for all other relevant independent variables.

Among VHA users with SCI, both MI and SUD were negatively associated with survival.

The negative association between survival and MI and SUD suggest the need for regular screening for these disorders in VHA users with SCI. Further research is needed to assess whether depression and SUD treatment provide a valuable opportunity for intervention and ultimately improve survival.

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