Depression, Alcohol Use Disorders, and Suicidal Behavior among Veterans

Veterans using the Veterans Health Administration (VHA) are at increased risk for suicide and the VHA is the largest healthcare system in the U.S., putting VHA at the forefront of national suicide prevention efforts. Alcohol use disorder (AUD) and depression are the two most common disorders among suicide decedents worldwide, a pattern that also holds for Veterans. However, there are few data on VHA services patterns as they relate to suicide attempts and suicides among Veterans with AUD or depression, and no solid data using large, prospective clinical samples. To address these gaps, the authors analyze a cohort of hospitalized Veterans with admission diagnoses of AUD, depression, or AUD plus depression. Analyses describe service utilization in the year following discharge, the prevalence and characteristics of suicide attempts and suicides during the year, time to these suicidal events, and predictors of these events. The authors also explore service utilization following the admission (e.g., time from discharge to first outpatient visit) as a predictor of suicide attempt and suicide. Data for this project are obtained from VA's national inpatient medical database and VA's suicide attempt and completion database. Analyses use tests of difference for frequencies and proportions, linear and non-linear regression, and time series analyses. Rates for suicide attempts and deaths from suicide are also presented. The analyses offer unique insights into treatment experiences, suicide attempts and suicides of Veterans following treatment for alcoholism, depression, or both conditions, with implications for improved surveillance and treatment of these high-risk individuals.