Study Examines Link between Psychiatric Diagnosis and Higher Risk of Suicide among Veterans
BACKGROUND:
Prior research has consistently found associations between psychiatric conditions and the risk of fatal and non-fatal suicide attempts. As part of VA’s ongoing evaluation of suicide risk among Veterans being treated in VA facilities, this study examined the impact of different psychiatric diagnoses on the risk of suicide. Using data from VA and the National Death Index, investigators identified more than 3 million Veterans who used VA healthcare services during FY99 and were diagnosed with a psychiatric disorder; their risk of suicide was followed until death or through FY06. The psychiatric diagnoses examined in this study included: depression, schizophrenia, bipolar disorder, substance use disorders (alcohol or drug), PTSD, and other anxiety disorders. Demographics (age and gender) also were examined.
FINDINGS:
- A clinical diagnosis of a psychiatric disorder increased the risk of subsequent suicide by 160%. Psychiatric diagnoses were an especially strong risk factor for suicide among women, increasing their risk of suicide more than 5-fold.
- Bipolar disorder was the least common diagnosis (only 3% of all Veterans studied), but was diagnosed in approximately 9% of all Veterans who died by suicide. A diagnosis of bipolar disorder increased the risk of suicide nearly 3-fold in men and 6-fold in women. Authors suggest this makes bipolar disorder particularly appropriate for targeted interventions (e.g., improving medication adherence).
- Slightly less than half (47%) of those who died by suicide had at least one psychiatric condition when they entered the study cohort. Following bipolar disorder, each of the other six disorders examined in this study was shown to increase the risk of suicide by a factor of 2-2.5 in men, but by a factor of 3.5 to 6 among women.
- Overall, suicides were more than three times as common in men than in women and were 37% to 77% more common in Veterans ages 30 and older than among those ages 18 to 29.
- Among more than 3 million Veterans who used VA healthcare in FY99, 7,684 died of suicide in the following seven years, for a rate of 38 suicides per 100,000 patient-years of follow-up.
LIMITATIONS:
- This study examined diagnoses based on data for VA healthcare users from FY99 as predictors of subsequent suicide. Due to the recent conflicts in Iraq and Afghanistan, situations influencing specific psychiatric disorders (e.g., PTSD) and the types of patients using VA services have changed. The extent to which the present results may shift over time is unknown.
- These data were acquired for policy and planning purposes, not for research.
AUTHOR/FUNDING INFORMATION:
This study was supported by VA’s Office of Mental Health Services and an HSR&D Career Development Award to Dr. Ilgen (MRP 05-137). Drs. Ilgen and Bohnert are part of HSR&D’s Center for Clinical Management Research in Ann Arbor, MI.
Ilgen M, Bohnert A, Ignacio R, et al. Psychiatric Diagnoses and Risk of Suicide in Veterans. Archives of General Psychiatry November 2010;67(11):1152-58.
