Suicide mortality among male veterans discharged from Veterans Health Administration acute psychiatric units from 2005 to 2010
Abstract
Purpose The purpose of this study was to calculate suicide rates and identify correlates of risk in the year following discharge from acute Veterans Health Administration psychiatric inpatient units among male veterans discharged from 2005 to 2010 (fiscal years).Methods Suicide rates and standardized mortality ratios were calculated. Descriptive analyses were used to describe suicides and non-suicides and provide base rates for interpretation, and unadjusted and adjusted proportional hazard models were used to identify correlates of suicide.Results From 2005 to 2010, 929 male veterans died by suicide in the year after discharge and the suicide rate was 297/100,000 person-years (py). The suicide rate significantly increased from 234/100,000 py (95% CI = 193-282) in 2005 to 340/100,000 py (95% CI = 292-393) in 2008, after which it plateaued. Living in a rural setting, HR (95% CI) = 1.20 (1.05, 1.36), and being diagnosed with a mood disorder such as major depression, HR (95% CI) = 1.60 (1.36, 1.87), or other anxiety disorder, HR (95% CI) = 1.52 (1.24, 1.87), were associated with increased risk for suicide.Conclusions Among male veterans, the suicide rate in the year after discharge from acute psychiatric hospitalization increased from 2005 to 2008, after which it plateaued. Prevention efforts should target psychiatrically hospitalized veterans who live in rural settings and/or are diagnosed with mood or other anxiety disorders.
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Postdischarge suicides are rare, about 3 per 1,000 hospitalizations.
“given the rarity of postdischarge suicides (about 3/1,000 hospitalizations) (6)”
From Using Administrative Data to Predict Suicide After Psychiatric Hospitalization in the Veterans Health Administration System (2020) · cites this paper as [6]
Approximately 1% of VHA patients hospitalized for psychiatric disorders each year account for nearly 12% of all VHA suicides over the subsequent 12 months.
“Indeed, the approximately 1% of Veteran Health Administration (VHA) patients who are hospitalized for psychiatric disorders each year account for nearly 12% of all VHA suicides over the subsequent 12 months (6).”
From Using Administrative Data to Predict Suicide After Psychiatric Hospitalization in the Veterans Health Administration System (2020) · cites this paper as [6]
VHA suicide prevention recommendations implemented beginning in 2008 were associated with a stabilization of the previously rising postdischarge suicide rate.
“These changes were associated with a stabilization of the previously rising postdischarge suicide rate, although the rate is still very high compared to others (6).”
From Using Administrative Data to Predict Suicide After Psychiatric Hospitalization in the Veterans Health Administration System (2020) · cites this paper as [6]
Cites
A combined comorbidity score predicted mortality in elderly patients better than existing scores
Gagne, J. J., Glynn, R. J., Avorn, J., Levin, R., & Schneeweiss, S. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.10.004 · Cited by 995 · see citing works
Suicide Risk in Relation to Psychiatric Hospitalization: Evidence Based on Longitudinal Registers
Qin, P., & Nordentoft, M. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.4.427 · Cited by 620 · see citing works
SIMPLE METHOD TO CALCULATE THE CONFIDENCE INTERVAL OF A STANDARDIZED MORTALITY RATIO (SMR)
Ulm, K. (1990) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a115507 · Cited by 552 · see citing works
Accuracy and completeness of mortality data in the Department of Veterans Affairs
Sohn, M., Arnold, N., Maynard, C. C., & Hynes, D. M. (2006) · Population Health Metrics · doi:10.1186/1478-7954-4-2 · Cited by 543 · see citing works
A Primer and Comparative Review of Major U.S. Mortality Databases
Cowper, D. C., Kubal, J. D., Maynard, C. C., & Hynes, D. M. (2002) · Annals of Epidemiology · doi:10.1016/s1047-2797(01)00285-x · Cited by 486 · see citing works
Kessler, R. C., Warner, C. H., Ivany, C., Petukhova, M. V., Rose, S., Bromet, E. J., Brown, M., Cai, T., Colpe, L. J., Cox, K. L., et al. (2015) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.1754 · Cited by 447 · see citing works
Psychiatric Diagnoses and Risk of Suicide in Veterans
Ilgen, M. A., Bohnert, A. S. B., Ignacio, R. V., McCarthy, J. F., Valenstein, M. M., Kim, H. M., & Blow, F. C. (2010) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2010.129 · Cited by 311 · cited 2× · see citing works
“Among psychiatric disorders, mood disorders, such as depression and bipolar disorder, and other anxiety disorders were also associated with increased suicide risk, replicating VHA general population findings [22].”
BackgroundSelf-citationMcCarthy, J. F., Bossarte, R. M., Katz, I. R., Thompson, C., Kemp, J., Hannemann, C. M., Nielson, C., & Schoenbaum, M. (2015) · American Journal of Public Health · doi:10.2105/ajph.2015.302737 · Cited by 251 · see citing works
Noncancer pain conditions and risk of suicide
Ilgen, M. A., Kleinberg, F., Ignacio, R. V., Bohnert, A. S. B., Valenstein, M., McCarthy, J. F., Blow, F. C., & Katz, I. R. (2013) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2013.908 · Cited by 238 · see citing works
Self-citationShort-term Suicide Risk After Psychiatric Hospital Discharge
Olfson, M., Wall, M. M., Wang, S., Crystal, S., Liu, S.-M., Gerhard, T., & Blanco, C. (2016) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2016.2035 · Cited by 233 · see citing works
Mental health service delivery and suicide risk: the role of individual patient and facility factors
Desai, R. A., Dausey, D. J., & Rosenheck, R. A. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.2.311 · Cited by 183 · see citing works
Dementia and suicidal behavior: a review of the literature
Haw, C., Harwood, D., & Hawton, K. (2009) · International Psychogeriatrics · doi:10.1017/s1041610209009065 · Cited by 166 · see citing works
The Suicide Risk of Discharged Psychiatric Patients
Ho, T. (2003) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v64n0613 · Cited by 143 · see citing works
Valenstein, M. M., Kim, H. M., Ganoczy, D. A., McCarthy, J. F., Zivin, K., Austin, K., Hoggatt, K. J., Eisenberg, D., Piette, J. D., Blow, F. C., et al. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.08.020 · Cited by 142 · see citing works
Mccarthy, J., Blow, F., Ignacio, R., Ilgen, M., Austin, K. L., & Valenstein, M. (2012) · American Journal of Public Health · doi:10.2105/ajph.2011.300463 · Cited by 136 · see citing works
Self-citationSleep Disturbance Preceding Suicide Among Veterans
Pigeon, W. R., Britton, P. C., Ilgen, M. A., Chapman, B. P., & Conner, K. R. (2012) · American Journal of Public Health · doi:10.2105/ajph.2011.300470 · Cited by 130 · see citing works
Self-citationForging an agenda for suicide prevention in the United States.
Caine, E. (2013) · American Journal of Public Health · doi:10.2105/ajph.2012.301078 · Cited by 129 · see citing works
Risk of suicide according to level of psychiatric treatment: a nationwide nested case–control study
Hjorthøj, C. R., Madsen, T., Agerbo, E., & Nordentoft, M. (2014) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-014-0860-x · Cited by 105 · see citing works
Suicide Mortality Among Patients Treated by the Veterans Health Administration From 2000 to 2007
Blow, F. C., Bohnert, A. M., Ilgen, M. A., Ignacio, R. V., McCarthy, J. F., Valenstein, M. M., & Knox, K. L. (2012) · American Journal of Public Health · doi:10.2105/ajph.2011.300441 · Cited by 96 · see citing works
Self-citationConner, K., Bossarte, R., He, H., Arora, J., Lu, N., Tu, X., & Katz, I. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.04.067 · Cited by 80 · see citing works
Uniform Mental Health Services in VA Medical Centers and Clinics
(2008) · PsycEXTRA Dataset · doi:10.1037/e553462011-001 · Cited by 72 · see citing works
Risk factors for suicide in the immediate post-discharge period
Kan, C.-K., Ho, T.-P., Dong, J. Y. S., & Dunn, E. L. W. (2007) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-006-0153-0 · Cited by 71 · see citing works
Psychiatric in-patient care and suicide in England, 1997 to 2008: a longitudinal study
Kapur, N., Hunt, I. M., Windfuhr, K. L., Rodway, C., Webb, R. T., Rahman, M. S., Shaw, J. J., & Appleby, L. (2012) · Psychological Medicine · doi:10.1017/s0033291712000864 · Cited by 60 · see citing works
Differences between veteran suicides with and without psychiatric symptoms.
Britton, P. C., Ilgen, M., Valenstein, M., Knox, K., Claassen, C., & Conner, K. (2012) · American Journal of Public Health · doi:10.2105/ajph.2011.300415 · Cited by 44 · see citing works
Self-citationSuicide among Discharged Psychiatric Inpatients in the Department of Veterans Affairs
Desai, R. A., Dausey, D. J., & Rosenheck, R. A. (2008) · Military Medicine · doi:10.7205/milmed.173.8.721 · Cited by 39 · see citing works
Madsen, T., & Nordentoft, M. (2013) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.13m08656 · Cited by 38 · see citing works
Britton, P. C., Stephens, B., Wu, J., Kane, C. P., Gallegos, A. M., Ashrafioun, L., Tu, X., & Conner, K. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.08.029 · Cited by 33 · see citing works
Self-citationAge and Suicide Among Veterans With a History of Homelessness
Bossarte, R. M., Piegari, R. I., Hill, L. L., & Kane, V. R. (2013) · Psychiatric Services · doi:10.1176/appi.ps.201300128 · Cited by 5 · see citing works
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Morales, D. A., Barksdale, C. L., & Beckel-Mitchener, A. C. (2020) · Journal of Clinical and Translational Science · doi:10.1017/cts.2020.42 · Cited by 494 · see citing works
Fox, V., Dalman, C., Dal, H., Hollander, A., Kirkbride, J., & Pitman, A. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.10.009 · Cited by 110 · see citing works
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Shiner, B. R., Peltzman, T., Cornelius, S. L., Gui, J., Forehand, J. A., & Watts, B. V. (2020) · Journal of Behavioral Medicine · doi:10.1007/s10865-020-00176-9 · Cited by 57 · see citing works
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Gradus, J. (2018) · Current Psychiatry Reports · doi:10.1007/s11920-018-0965-0 · Cited by 49 · see citing works
Kessler, R. C., Bauer, M. S., Bishop, T. M., Demler, O. V., Dobscha, S. K., Gildea, S. M., Goulet, J. L., Karras, E., Kreyenbuhl, J., Landes, S. J., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00390 · Cited by 52 · see citing works
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White, J. H., & Morris, J. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16183236 · Cited by 36 · see citing works
Cooper, S. A., Szymanski, B. R., Bohnert, K. M., Sripada, R. K., & McCarthy, J. F. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.15707 · Cited by 29 · see citing works
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Self-citation
- Authors
- Britton, P. C., Bohnert, K. M., Ilgen, M. A., Kane, C., Stephens, B., & Pigeon, W. R.
- Affiliations
- United States Department of Veterans Affairs (US)
- University of Michigan (US)
- Corresponding author
- Britton, Peter C.
- Venue
- Social Psychiatry and Psychiatric Epidemiology
- Published
- 2017-04-11
- Volume
- 52
- Issue
- 9
- Pages
- 1081-1087
- ISSN
- 0933-7954 (ISSN-L)
- 1433-9285
- OpenAlex
- W2606497050
- Cited by
- 41
- References
- 28
- Citations by year
- 2025: 1 · 2024: 4 · 2023: 2 · 2022: 5 · 2021: 9 · 2020: 10 · 2019: 7 · 2018: 3
- FWCI
- 6.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs (IK2CX000641, CDA 11-245)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- suicide mortality, male veterans, psychiatric hospitalization, acute psychiatric inpatient unit, rural residence, mood disorders, major depressive disorder, anxiety disorders, suicide prevention, Veterans Health Administration
- MeSH terms
- Adolescent, Adult, Aged, Mental Disorders, Hospitals, Psychiatric, Humans, Male, Middle Aged, Mortality, Patient Discharge, Risk Factors, Rural Population, Suicide, United States, United States Department of Veterans Affairs, Veterans, Young Adult
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