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 Overall, male veterans with drug or alcohol problems are more than
twice as likely to die by suicide as other ex-service members,
researchers report in the journal Addiction. For female veterans
with substance use disorders, the odds of death from suicide are
almost six times higher.
The suicide risk is particularly high when veterans misuse
prescription sedatives, with more than quadrupled odds of suicide
for men and more than 11 times the risk for women, the study also
found. Among female veterans, opioids were also tied to a nearly
eight-times-higher risk of suicide, while amphetamines and
stimulants were tied to almost six times the risk.
“Previous studies have linked substance use disorders with an
increased risk of suicide in both general population and Veteran
samples; however, because suicide is a relatively rare outcome,
prior studies have tended to group substance use disorders into
broad categories,” said lead study author Kipling Bohnert of the VA
Center for Clinical Management Research and the University of
Michigan in Ann Arbor.
“Our investigation is one of the first to provide estimates of the
suicide risk associated with cannabis, cocaine, amphetamine and
sedative use disorders in the same large population, and compare
risks associated with these specific substance use disorders between
men and women,” Bohnert said by email.
For the study, researchers examined medical data and death records
for more than 4.4 million veterans who received care through the
Veterans Health Administration in 2004 and 2005. They followed
veterans for six years.
At the start of the study, 8.3 percent of men and 3.4 percent of
women had a substance use disorder.
During the study, 9,087 veterans died by suicide, for a suicide rate
of 34.7 cases per 100,000 person-years.
For veterans with a substance use problem, the overall suicide rate
was 75.6 cases per 100,000 person years. Men had a slightly higher
rate of 76.1 cases, while women had a lower rate overall of 63.4
cases per 100,000 person-years.
Two-thirds of the suicides involved firearms, and another
one-quarter were by intentional poisoning, the study found.
After researchers accounted for veterans’ age and the severity of
any medical conditions, the increased risk of suicide associated
with substance abuse diminished somewhat but remained meaningful in
most cases.
Once researchers also factored in mental health diagnoses, however,
the findings changed. Differences between men and women diminished,
and only alcohol and opioid misuse remained associated with an
elevated suicide risk for female veterans.
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One limitation of the study is that it only included VA patients,
who tend to have poorer physical and mental health than other
veterans, the authors note. Because the cause of death for suicides
is often classified as an accidental overdose, it’s also possible
that the study might have underestimated the odds of suicide for
certain substance use disorders, the researchers point out.
“We knew that a diagnosis of a substance use disorder increased risk
for suicide, but this paper illustrates that not all substance use
disorders are the same,” said Rajeev Ramchand, a researcher in
military mental health and suicide prevention at Rand Corporation
who wasn't involved in the study.
“There is an opiate crisis in America, including among our veterans,
and this paper provides evidence that opiate addiction and suicide
are strongly linked,” Ramchand said by email.
For veterans in particular, the transition from military to civilian
life and problems with finances, housing, or spouses can be
stressful circumstances that may make substance use or suicide
attempts more likely, said Yu-Chu Shen, a researcher at the Naval
Postgraduate School in Monterey, California, who wasn’t involved in
the study.
“In addition, clinicians should be aware that deployments may
increase suicide risk independently of underlying mental disorders,
and so asking patients about deployment history is advisable,” Shen
said by email. “Substance use disorder is not the only psychiatric
condition associated with elevated risk of suicide - other
psychiatric disorders and any previous attempts of suicide are major
markers.”
SOURCE: http://bit.ly/2mZwyK2 Addiction, online March 16, 2017.
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