The most comprehensive study of veteran depression and suicide to date has been completed and the full results will be reported in the December issue of American Journal of Public Health which will focus specifically on veteran's issues.
Researchers from the VA Ann Arbor Healthcare System and the University of Michigan Health System and U-M Depression Center, analyzed comprehensive data from 807,694 veterans of all ages diagnosed with depression and treated at any Veterans Affairs facility nationwide between 1999 and 2004. The data is from the VA's National Registry for Depression, developed and maintained by the Serious Mental Illness Treatment Research and Evaluation Center at the VA Ann Arbor's Health Services Research and Development Center of Excellence.
Of the total number of veterans diagnosed with depression, 1,683 of the depressed veterans committed suicide during the study period, a representation of 0.21 percent of those studied. The group then analyzed the characteristics of all the depressed veterans who committed suicide, and calculated suicide hazard ratios and suicide rates per 100,000 person-years (PY) for each subgroup.
First, author Kara Zivin, Ph.D., a VA investigator and assistant professor in the U-M Department of Psychiatry, pointed out that veterans who committed suicide do not necessarily meet the standard criteria that therapists look for in their patients. "Doctors learn about patient characteristics that might increase risk of suicide. Typically, these are older age, male gender, and white race, as well as (having) depression, and medical or substance abuse issues. But our study indicates that among veterans in depression treatment, the predictors of suicide may not be the same. We hope our findings will help guide physicians in understanding suicide risk among currently depressed veterans."
One finding was unexpected. Depressed veterans who did not have a service-connected disability were more likely to commit suicide than those with a service-connected disability. The researchers speculated that this may be due to greater access to treatments among service-connected veterans, or more stable incomes due to compensation payments.
Senior author Marcia Valenstein, M.D., an associate professor of psychiatry at U-M and leader of this study, explained "We are also examining whether there are specific periods during depression treatment when veterans are at higher risk and might need higher levels of monitoring," says Valenstein. "In addition, we are examining whether different types of depression treatments, such as different antidepressants or sleeping medications, are associated with different rates of suicide."
The most surprising finding, according to the researchers a suicide rate of 68.16 per 100,000 PY for depressed veterans who also had post-traumatic stress disorder (PTSD), compared with a rate of 90.66 for those who did not. This finding led the researchers to dig deeper and look at whether specific subgroups of depressed veterans with PTSD had higher or lower suicide risk. Further examination demonstrated that the “protective” effect of having PTSD in addition to depression was strongest among veterans in the two older age groups (18 to 44 years, 45 to 64 years, and 65 years or older).
The authors say their study does not reveal a reason for this "protective" effect, but they theorize that it may be due to the high level of attention to PTSD treatment in the VA system and the greater likelihood that patients with PTSD will receive psychotherapy. More study is necessary, they say.
Additional study information can be found here.
del.icio.us |
digg |
FURL |
Netscape |
reddit |
Stumble! |
My Web
