ABSTRACT
BACKGROUND
Veterans receiving Veterans Affairs (VA) healthcare have increased suicide risk compared to the general population. Many patients see primary care clinicians prior to suicide. Yet little is known about the correlates of suicide among patients who receive primary care treatment prior to death.
OBJECTIVE
Our aim was to describe characteristics of veterans who received VA primary care in the 6 months prior to suicide; and to compare these to characteristics of control patients who also received VA primary care.
DESIGN
This was a retrospective case–control study.
SUBJECTS
The investigators partnered with VA operations leaders to obtain death certificate data from 11 states for veterans who died by suicide in 2009. Cases were matched 1:2 to controls based on age, sex, and clinician.
MAIN MEASURES
Demographic, diagnosis, and utilization data were obtained from VA’s Corporate Data Warehouse. Additional clinical and psychosocial context data were collected using manual medical record review. Multivariate conditional logistic regression was used to examine associations between potential predictor variables and suicide.
KEY RESULTS
Two hundred and sixty-nine veteran cases were matched to 538 controls. Average subject age was 63 years; 97 % were male. Rates of mental health conditions, functional decline, sleep disturbance, suicidal ideation, and psychosocial stressors were all significantly greater in cases compared to controls. In the final model describing men in the sample, non-white race (OR = 0.51; 95 % CI = 0.27–0.98) and VA service-connected disability (OR = 0.54; 95 % CI = 0.36–0.80) were associated with decreased odds of suicide, while anxiety disorder (OR = 3.52; 95 % CI = 1.79–6.92), functional decline (OR = 2.52; 95 % CI = 1.55–4.10), depression (OR = 1.82; 95 % CI = 1.07–3.10), and endorsement of suicidal ideation (OR = 2.27; 95 % CI = 1.07–4.83) were associated with greater odds of suicide.
CONCLUSIONS
Assessment for anxiety disorders and functional decline in addition to suicidal ideation and depression may be especially important for determining suicide risk in this population. Continued development of interventions that support identifying and addressing these conditions in primary care is indicated.
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Contributors
We wish to acknowledge April Lee MPH, Holly Bratkovich BA, Anna Beane BA, and Joe Warren MA for assistance in developing study procedures and reviewing the medical records.
Funders
This material is based upon work supported by the Department of Veterans Affairs, the Veterans Health Administration, and Health Services Research and Development Service Project IIR 10–331, VA Mental Health Services-Suicide Prevention Program, and VISN 2 Center of Excellence for Suicide Prevention. Dr. Dobscha is the Director of the Center to Improve Veteran Involvement in Care (CIVIC) at the Portland VA Medical Center. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
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The authors declare that they do not have a conflict of interest.
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Dobscha, S.K., Denneson, L.M., Kovas, A.E. et al. Correlates of Suicide Among Veterans Treated in Primary Care: Case–Control Study of a Nationally Representative Sample. J GEN INTERN MED 29 (Suppl 4), 853–860 (2014). https://doi.org/10.1007/s11606-014-3028-1
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DOI: https://doi.org/10.1007/s11606-014-3028-1