Differences between veteran suicides with and without psychiatric symptoms.
ABSTRACT Our objective was to examine all suicides (n = 423) in 2 geographic areas of the Veterans Health Administration (VHA) over a 7-year period and to perform detailed chart reviews on the subsample that had a VHA visit in the last year of life (n = 381).
Within this sample, we compared a group with 1 or more documented psychiatric symptoms (68.5%) to a group with no such symptoms (31.5%). The groups were compared on suicidal thoughts and behaviors, somatic symptoms, and stressors using the χ(2) test and on time to death after the last visit using survival analyses.
Veterans with documented psychiatric symptoms were more likely to receive a suicide risk assessment, and have suicidal ideation and a suicide plan, sleep problems, pain, and several stressors. These veterans were also more likely to die in the 60 days after their last visit.
Findings indicated presence of 2 large and distinct groups of veterans at risk for suicide in the VHA, underscoring the value of tailored prevention strategies, including approaches suitable for those without identified psychiatric symptoms.
- SourceAvailable from: Erin Finley[Show abstract] [Hide abstract]
ABSTRACT: Objectives. We examined the association of posttraumatic stress disorder (PTSD), traumatic brain injury, and chronic pain-the polytrauma clinical triad (PCT)-independently and with other conditions, with suicide-related behavior (SRB) risk among Operation Enduring Freedom (OEF; Afghanistan) and Operation Iraqi Freedom (OIF) veterans. Methods. We used Department of Veterans Affairs (VA) administrative data to identify OEF and OIF veterans receiving VA care in fiscal years 2009-2011; we used International Classification of Diseases, Ninth Revision, Clinical Modification codes to characterize 211 652 cohort members. Descriptive statistics were followed by multinomial logistic regression analyses predicting SRB. Results. Co-occurrence of PCT conditions was associated with significant increase in suicide ideation risk (odds ratio [OR] = 1.9; 95% confidence interval [CI] = 1.5, 2.4) or attempt and ideation (OR = 2.6; 95% CI = 1.5, 4.6), but did not exceed increased risk with PTSD alone (ideation: OR = 2.3; 95% CI = 2.0, 2.6; attempt: OR = 2.0; 95% CI = 1.4, 2.9; ideation and attempt: OR = 1.8; 95% CI = 1.2, 2.8). Ideation risk was significantly elevated when PTSD was comorbid with depression (OR = 4.2; 95% CI = 3.6, 4.8) or substance abuse (OR = 4.7; 95% CI = 3.9, 5.6). Conclusions. Although PCT was a moderate SRB predictor, interactions among PCT conditions, particularly PTSD, and depression or substance abuse had larger risk increases. (Am J Public Health. Published online ahead of print July 17, 2014: e1-e8. doi:10.2105/AJPH.2014.301957).American Journal of Public Health 07/2014; · 4.23 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Besides several risk factors for suicide, there is a recent increase in clinical and epidemiological studies pointing to a potential relationship between sleep loss or sleep disturbances and suicidality. This work, based on a systematic literature research, gives an overview on the findings of relationships between suicidality (i. e., suicidal thoughts, suicide attempts, suicides) and sleep disturbances, especially insomnia, nightmares, but also hypersomnia and nocturnal panic attacks. There is evidence that sleep disturbances in suicidal insomniacs with comorbid psychiatric disorder are independently predictive for suicidality, too. Shared aspects of pathogenesis of the two entities and therapeutic options are also discussed. Recognition of sleep disturbances is essential for suicide prevention in clinical practice.Fortschritte der Neurologie · Psychiatrie 10/2013; 81(10):561-569. · 0.85 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Suicide is a major public health concern among U.S. veterans. Even when asked directly, veterans who die by suicide have been found to deny suicidal thoughts. Psychological assessment needs to go beyond the current risk factors and evaluate underlying factors that may increase suicide risk. In the present study, diagnostic interviews and self-report questionnaires were used to measure life meaning and suicidal ideation in a sample of 110 depressed veterans. Life meaning was significantly associated with suicidal ideation, even after accounting for depression and suicide history. Life meaning may be an important, previously ignored indicator of suicide risk.Death Studies 06/2014; · 0.92 Impact Factor