Suicide Mortality Among Patients Treated by the Veterans Health Administration From 2000 to 2007

Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC) and Health Services Research and Development Center of Excellence, Ann Arbor, MI, USA.
American Journal of Public Health (Impact Factor: 4.23). 03/2012; 102 Suppl 1:S98-104. DOI: 10.2105/AJPH.2011.300441
Source: PubMed

ABSTRACT We sought to examine rates of suicide among individuals receiving health care services in Veterans Health Administration (VHA) facilities over an 8-year period.
We included annual cohorts of all individuals who received VHA health care services from fiscal year (FY) 2000 through FY 2007 (October 1, 1999-September 30, 2007; N = 8,855,655). Vital status and cause of death were obtained from the National Death Index.
Suicide was more common among VHA patients than members of the general US population. The overall rates of suicide among VHA patients decreased slightly but significantly from 2000 to 2007 (P < .001). Male veterans between the ages of 30 and 64 years were at the highest risk of suicide.
VHA health care system patients are at elevated risk for suicide and are appropriate for suicide reduction services, although the rate of suicide has decreased in recent years for this group. Comprehensive approaches to suicide prevention in the VHA focus not only on recent returnees from Iraq and Afghanistan but also on middle-aged and older Veterans.

  • Social Work in Mental Health 10/2014; 12(5-6):429-442. DOI:10.1080/15332985.2013.854286
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    ABSTRACT: Background Lithium has been reported in some, but not all, studies to be associated with reduced risk of suicide death or suicidal behavior. The objective of this nonrandomized cohort study was to examine whether lithium was associated with reduced risk of suicide death in comparison to the commonly-used alternative treatment, valproate.MethodsA propensity score-matched cohort study was conducted of Veterans Health Administration patients (n¿=¿21,194/treatment) initiating lithium or valproate from 1999¿2008.ResultsMatching produced lithium and valproate treatment groups that were highly similar in all 934 propensity score covariates, including indicators of recent suicidal behavior, but recent suicidal ideation was not able to be included. In the few individuals with recently diagnosed suicidal ideation, a significant imbalance existed with suicidal ideation more prevalent at baseline among individuals initiating lithium than valproate (odds ratio (OR) 1.30, 95% CI 1.09, 1.54; p¿=¿0.003). No significant differences in suicide death were observed over 0¿365 days in A) the primary intent-to-treat analysis (lithium/valproate conditional odds ratio (cOR) 1.22, 95% CI 0.82, 1.81; p¿=¿0.32); B) during receipt of initial lithium or valproate treatment (cOR 0.86, 0.46, 1.61; p¿=¿0.63); or C) after such treatment had been discontinued/modified (OR 1.51, 95% CI 0.91, 2.50; p¿=¿0.11). Significantly increased risks of suicide death were observed after the discontinuation/modification of lithium, compared to valproate, treatment over the first 180 days (OR 2.72, 95% CI 1.21, 6.11; p¿=¿0.015).Conclusions In this somewhat distinct sample (a predominantly male Veteran sample with a broad range of psychiatric diagnoses), no significant differences in associations with suicide death were observed between lithium and valproate treatment over 365 days. The only significant difference was observed over 0¿180 days: an increased risk of suicide death, among individuals discontinuing or modifying lithium, compared to valproate, treatment. This difference could reflect risks either related to lithium discontinuation or higher baseline risks among lithium recipients (i.e., confounding) that became more evident when treatment stopped. Our findings therefore support educating patients and providers about possible suicide-related risks of discontinuing lithium even shortly after treatment initiation, and the close monitoring of patients after lithium discontinuation, if feasible. If our findings include residual confounding biasing against lithium, however, as suggested by the differences observed in diagnosed suicidal ideation, then the degree of beneficial reduction in suicide death risk associated with lithium treatment would be underestimated. Further research is urgently needed, given the lack of interventions against suicide and the uncertainties concerning the degree to which lithium may reduce suicide risk during active treatment, increase risk upon discontinuation, or both.
    BMC Psychiatry 12/2014; 14(1):357. DOI:10.1186/s12888-014-0357-x · 2.24 Impact Factor
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    ABSTRACT: Research conducted in the civilian population demonstrates that cognitive-behavioral therapies are effective for depression, but some evidence suggests that Veterans' treatment response may differ from civilians. This review examined cognitive-behavioral treatment (CBT) for depression in Veteran samples. A literature search for treatment outcome studies with Veteran samples was conducted using PsycInfo, PubMed, and SCOPUS databases. Nine studies met inclusion criteria and were assessed for methodological rigor (randomized controlled trials = 5; open trials = 4). Controlled effect sizes were compared for randomized controlled trials, and pre-post effect sizes were used to compare treatment groups across all studies. The open trials reviewed demonstrated large pre-post effect sizes, though these studies were of lower methodological quality. CBT performed better than control treatment in only two of five randomized controlled trials reviewed, a finding that contrasts with research in non-Veteran samples. Possible reasons for these findings are discussed, including psychosocial factors that may influence the course of depression treatment in Veterans. Additional high quality research is needed to conclusively determine if depression treatment outcomes differ for Veterans and, if so, what modifications to current CBT protocols might enhance response to treatment.
    Military medicine 09/2014; 179(9):942-949. DOI:10.7205/MILMED-D-14-00128 · 0.77 Impact Factor

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