Findings point to the need for more suicide
prevention efforts among veterans with substance use disorders, especially
those who also have mental health conditions...Rates of suicide for
veterans, calculated by a University of Michigan/VA team based on data from 4.4
million veterans over 6 years.
Newswise, March 20, 2017 —– Veterans
who have drug or alcohol problems are more than twice as likely to die by
suicide as their comrades, a new study finds. And women veterans with substance
use disorders have an even higher rate of suicide -- more than five times that
of their peers, the research shows.
The risk of suicide differs
depending on the type of substance the veteran has problems with, according to
the study.
The highest suicide risks are among
those who misuse prescription sedative medicines, such as tranquilizers. Women
veterans who misuse opioid drugs also have an especially high risk of suicide,
the study finds.
The research, published in the
journal Addiction by a team from the University of Michigan and Department of
Veterans Affairs, finds that much of the difference in suicide risks might be
explained by veterans who have both mental health conditions and substance use
issues.
But they say the new findings point
to a need to focus more veteran suicide-prevention efforts on those who have
substance use disorders, especially if they also have depression,
schizophrenia, bipolar disorder, post-traumatic stress disorder or anxiety.
The new findings come from one of
the largest-ever examinations of substance use disorders and suicide, involving
more than 4.4 million veterans.
“We hope these findings will help
clinicians and health systems care for people with substance use disorders,
with mental health conditions, and with both -- and focus suicide prevention
efforts accordingly,” says Kipling Bohnert, Ph.D., lead author of the study and
researcher with the VA Center for Clinical Management Research who is also an
assistant professor of psychiatry at the U-M Medical School. “Substance use
disorders may be important markers for suicide risk.”
Twenty veterans die by suicide each
day – a much higher rate than in the general population.
Because two-thirds of the suicides
in the study involved firearms, the researchers also note that firearm safety
is important in efforts to reduce the toll of suicide on those who have served
the nation.
In addition, one-quarter of suicides
among veterans with substance use disorders were by intentional poisoning,
highlighting the need for strategies to prevent that form of suicide in this
group.
The researchers say their work may
have implications for the civilian population as well, but that it’s harder to
study individuals outside the VA in the same way because records aren’t
centralized like they are at the VA.
About the study
Bohnert and his colleagues from the
Department of Veterans Affairs, U-M Addiction Center and U-M Institute for
Healthcare Policy and Innovation looked at VA records from a large group of
veterans who saw a VA provider in 2004 and 2005. They then tracked suicides
among this group over the next six years.
In all, 8.3 percent of men and 3.4
percent of women in the cohort had a substance use disorder recorded in their
list of diagnoses in 2004-2005. And 9,087 of the veterans in the study group
died by suicide during the follow-up years.
Using statistical techniques, the
team calculated suicide rates per 100,000 person-years, and then calculated
those rates for veterans with substance use issues overall, and for specific
substance use disorders.
In all, the suicide rate was 75.6
for veterans with any substance use disorder, compared with 34.7 for veterans
overall. A previous study led by Mark Ilgen, Ph.D., co-author on the new study,
found similarly higher rates in veterans who were tracked from 1999 to 2006.
But the new study lets the
researchers drill down to the specific substance that veterans had problems
with, including alcohol, opioids, marijuana, and cocaine.
The study found the suicide risk was
highest for veterans of both genders who misused sedatives – 171.4 per 100,000
person-years – and markedly higher for women who misused opioids, at 98.6 per
100,000 person-years.
The researchers couldn’t distinguish
between misuse of prescription opioids and problems with other non-prescription
opioids, such as heroin.
Men who misused amphetamines also
had a suicide rate of 95 per 100,000 person-years. The study couldn’t tell
whether they were misusing prescription amphetamines, such as those used for
attention deficit disorder, or using illicit drugs such as methamphetamine.
The researchers then took into
account veterans’ age and the overall severity of their medical conditions, and
calculated the risk of suicide by type of substance use disorder.
This reduced the size of the
difference in suicide risks somewhat but most of the original relationships
remained.
When the researchers factored in
mental health diagnoses, the picture changed. Among women, only alcohol and
opioid disorders remained associated with higher suicide risk, independent of
mental and physical health. Differences between men and women diminished as
well.
But both genders with substance use
disorders had a higher rate of suicide even after differences in physical and
mental health were factored in.
In all, says Bohnert, “Assessment
and treatment of co-existing psychiatric conditions, in addition to substance
use, may be important in lowering the risk of suicide among individuals who
have substance use disorders.”
In addition to Bohnert and Ilgen,
the study was conducted by Samantha Louzon and John F. McCarthy, Ph.D., of the
VA Serious Mental Illness Treatment Resource and Education Center, and Ira R.
Katz of the VA Office of Mental Health Services.
The study was funded by the
Department of Veterans Affairs. Reference: Addiction, Early View,
doi:10.1111/add.13774 Veterans in crisis should call the Veterans Crisis Line
at 800-273-8255 (press 1), or text 838255.
