Study Examines Characteristics Associated with Suicide among Male Veterans Treated in VA Primary Care
BACKGROUND:
Suicide prevention has been designated a "national imperative" in the United States. Veterans treated in the VA healthcare system have greater risk for suicide compared to the general population, thus addressing suicide among Veterans is a high priority. Approximately half of suicide decedents have contact with primary care clinicians in the month prior to death. However, there are a number of challenges to enhancing suicide prevention in primary care, including a lack of information about Veterans treated in primary care who subsequently die by suicide. This retrospective, case control study sought to identify characteristics of Veterans (n=261) who received VA primary care in the six months prior to suicide (in 2009) – and compare these to control patients (n=522) who also received primary care at the same 41 VA facilities in 11 geographically diverse states. Using VA data, investigators compared several measures, including demographics, clinical characteristics (e.g., psychiatric and/or medical comorbidities) and psychosocial factors (e.g., isolation, grief, legal problems). Investigators also assessed for documented sleep problems, functional decline, anger, and suicidal ideation. All Veterans in this study were male, and the mean age was 63.
FINDINGS:
- Compared to controls, Veterans who died by suicide were significantly more likely to be unmarried, white, and to have major depression, bipolar disorder, anxiety disorder other than PTSD, and/or an alcohol or other substance use disorder diagnosis.
- Veterans who died by suicide also were more likely to have documented functional decline, sleep disturbance, expressions of anger, and suicidal ideation. In multivariable models, the odds of dying by suicide were greatest among Veterans with anxiety disorder diagnoses and functional decline.
- A diagnosis of PTSD was not significantly associated with suicide, nor was a pain diagnosis or general medical comorbidity. Also, non-white race and a VA service-connected disability rating were associated with decreased odds of suicide.
LIMITATIONS:
- Differences in mortality reporting across states and misclassification of Veteran status may have affected study estimates.
- Investigators did not have access to patient-level measures. Data were dependent upon the accuracy and extent of clinician and staff documentation in the medical record.
IMPLICATIONS:
- The assessment of anxiety disorders and functional decline, in particular, may be important for determining suicide risk among Veterans. The authors suggest continued development of interventions that support identifying and addressing these conditions in primary care.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D (IIR 10-331). Drs. Dobscha, Denneson, and Kovas are part of HSR&D's Center to Improve Veteran Involvement in Care, Portland, OR.
Dobscha S, Denneson L, Kovas A, et al. Correlates of Suicide among Veterans Treated in Primary Care: Case-control Study of a Nationally Representative Sample. Journal of General Internal Medicine. December 2014;29 Suppl 4:853-60.
