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02-11-2010 | Article

Suicide risk high in veterans with bipolar disorder or substance abuse


Free abstract

MedWire News: Of all psychiatric diagnoses in military veterans, bipolar disorder is associated with greatest risk for suicide in men and substance use disorder is associated with the greatest risk in women, US research shows.

"Prior research has consistently found associations between psychiatric conditions (eg, depression, bipolar disorder, post-traumatic stress disorder [PTSD], schizophrenia, and alcohol and/or drug use disorders) and risk of fatal and nonfatal suicide attempts," write Mark Ilgen (University of Michigan, Ann Arbor) and colleagues.

"However, determining the relative contribution of each of these disorders to risk of suicide is difficult because of (1) differences in the method of recruitment of the samples and assessment of the different diagnoses, (2) concerns that results related to nonfatal suicide attempts may not generalize to the study of suicide mortality, and (3) the low numbers of suicides in many of the studies," they add.

To address these issues, the researchers studied data on 3,291,891 patients who used Veterans Health Administration (VHA) services in the USA during 1999. These individuals were followed up until death or the end of 2006, whichever came first.

Overall, 25.6% of these patients were diagnosed with at least one psychiatric disorder, with the most common diagnostic categories being depression (14.5%) and substance use disorders (10.0%).

Examination of data from the National Death Index revealed that a total of 7684 veterans who had used VHA services in the 1999 had died by suicide by the end of 2006.

Analysis showed that the presence of any psychiatric diagnosis was associated with an increased risk for suicide during follow-up, at a hazard ratio of 2.60.

Of all psychiatric conditions, bipolar disorder was associated with the greatest risk for suicide (HR=3.19), followed by depression (HR=2.70), substance use disorders (HR=2.47), schizophrenia (HR=2.33), other anxiety disorders (HR=2.21), and PTSD (HR=1.93).

Analysis by gender revealed that bipolar disorder was associated with the greatest risk for suicide in men (HR=2.98), while substance use disorder was associated with the greatest risk in women (HR=6.62).

Ilgen and team conclude in the Archives of General Psychiatry: "A clinical diagnosis of a psychiatric disorder was strongly associated with increased risk of subsequent suicide in the population of all patients who used services from the VHA within a given year."

They add: "These findings highlight the importance of improved identification, diagnosis, and treatment of psychiatric diagnoses (particularly bipolar disorder, depression, substance use disorders, and schizophrenia) [in] all healthcare system users."

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Mark Cowen