Prescription Drug and Alcohol Misuse Associated with Higher Suicide Deaths among Veterans with Depression
Clinicians need to assess important predictors of suicide as they complete suicide assessments, health systems need to assess risk factors as they monitor suicide rates in their facilities, and researchers need to account for known risk factors as they assess the relative importance of new risk factors. Several variables, such as gender, age, ethnicity, and mental health diagnoses that have been associated with suicide risk are easily observed or ascertained by clinicians, and sometimes easily obtained from healthcare administrative data. Standard medical documentation in electronic medical records from routine clinical visits also may provide valuable information concerning suicide risk. This retrospective study sought to assess the association between factors noted in the electronic medical record and suicide mortality, adjusting for variables readily available in health system administrative data for a cohort of Veterans who had received treatment for depression. Investigators identified 636 Veterans (324 who died by suicide and 312 control patients) with depression diagnoses who received VA care from 4/99 to 9/04. Veterans with a diagnosis of bipolar disorder, schizophrenia, or schizoaffective disorder were excluded from this study. Variables based on administrative data included demographics, service-connectedness, and various medical diagnoses. Variables based on chart notes included clinical symptoms and diagnoses; substance use; life stressors; suicide risk-behaviors, such as suicide attempts and ideation; and mental health or substance use treatments, including homelessness interventions.
- Even after adjusting for administratively available data, suicidal behaviors and substance-related variables were the strongest independent predictors of suicide.
- Compared with Veterans without a suicide attempt or ideation, those with a suicide attempt in the prior year were 6.6 times more likely to die of suicide, and Veterans with suicidal ideation without an attempt were 3.2 times more likely to die of suicide.
- Veterans with prescription drug misuse and those with alcohol abuse were 6.8 times and 3.3 times, respectively, more likely to die of suicide than those without. Based on these findings, the authors suggest that prescription drug and alcohol misuse assessments should be prioritized in suicide assessments among Veterans diagnosed with a depressive disorder.
- Veterans for whom providers considered a hospitalization for psychological issues had 2.9 times higher risk of suicide death than those for whom hospitalization was not considered.
- This study cohort was primarily male, therefore any gender differences in health behaviors and how they relate to suicide mortality risks need to be evaluated in additional populations.
Drs. Kim, Ilgen, Bohnert, and Valenstein, and Ms. Ganoczy are part of HSR&D's Center for Clinical Management Research, Ann Arbor, MI. Dr. Smith was supported through an HSR&D Career Development Award and is part of HSR&D's Center for Health Quality, Outcomes, and Economic Research, Bedford, MA.
Kim HM, Smith E, Ganoczy D, Walters H, Stano C, Ilgen M, Bohnert A, and Valenstein M. Predictors of Suicide in Patient Charts among Patients with Depression: Importance of Prescription Drug and Alcohol Abuse. Journal of Clinical Psychiatry October 2012;73(10):e1269-e1275.