247337 Suicide among patients in the Veterans Affairs health system: Rural urban differences in rates, risks and methods

Monday, October 31, 2011: 9:10 AM

John F. McCarthy, PhD, MPH , SMITREC; Department of Psychiatry, Veterans Affairs; University of Michigan, Ann Arbor, MI
Frederic C. Blow, PhD , Dept. of Veterans Affairs, Health Services Research & Development, Serious Mental Illness Treatment Research & Eval. Center;, Department of Psychiatry, University of Michigan, Ann Arbor, MI
Rosalinda Ignacio, MS , Smitrec, Department of Veterans Affairs, Ann Arbor, MI
Mark Ilgen, PhD , VISN 11 Serious Mental Illness Treatment Resource and Evaluation, Ann Arbor VA Medical Center, Ann Arbor, MI
Karen Austin, MPH , Smitrec, Department of Veterans Affairs, Ann Arbor, MI
Marcia Valenstein, MD, MS , Department of Psychiatry, University of Michigan, Ann Arbor, MI
Objectives: Suicide among Veterans is a national concern. The Veterans Affairs (VA) health system is the largest integrated health system in the United States. The VA serves a population that is disproportionately and increasingly rural, and suicide may be more frequent in rural patients. Using national patient cohorts, we assessed rural-urban differences in suicide rates, risks, and methods. Methods: We identified all VA patients in fiscal years 2003-2004 (FY03-04) alive at the start of FY04 (N=5,447,257), and all patients in FY06-07 alive at the start of FY07 (N=5,722,829). Mortality (FY04-05, FY07-08) was assessed from National Death Index searches. Census criteria defined rurality. Proportional hazards regressions calculated rural-urban differences in risks, controlling for age, sex, psychiatric diagnoses, VA mental health services accessibility, and regional administrative network. Suicide method was categorized as firearms, poisoning, strangulation, or other. Results: Rural patients had greater suicide rates (38.8 vs. 31.4/100,000 person-years in FY04-05; 39.6 vs. 32.3/100,000 in FY07-08). In multivariable analyses, rural residence was associated with greater suicide risks (20% greater, FY04-05; 22% greater, FY07-08). Firearm deaths were more common in rural suicides (76.6% vs. 61.5% in FY07-08). Conclusions: Rural residence is a substantial suicide risk factor, even controlling for mental health accessibility. Suicide prevention, gun safety, and treatment enhancements should specifically address risks in rural patients.

Learning Areas:

Learning Objectives:
1. Define a rural area using US Census criteria. 2. Describe current literature regarding suicide rates among men and women in rural versus urban areas in the United States. 3. Explain three factors that may exacerbate suicide risks in rural areas. 4. Compare suicide rates, risks and methods among patients in the national Veterans Affairs (VA) health system who reside in rural versus urban areas.

Keywords: Suicide, Rural Communities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I supervise and plan analyses for ongoing VA health system suicide monitoring and assessment.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.