An elevated risk of suicide haunts those veterans who return with a mental illness. But vets who have been diagnosed with bipolar disorder appear to be at substantially greater risk for suicide.
Mark A. Ilgen, Ph.D. and colleagues at the Department of Veterans Affairs (VA) Healthcare System and the University of Michigan examined the associations between different types of psychiatric diagnoses and suicide risk among more than 3 million veterans who received any type of care at a VA facility in 1999 and were alive at the beginning of 2000.
Psychiatric diagnoses were obtained from 1998 and 1999 treatment records and deaths by suicide were tracked over the following seven years.
During this follow-up period, 7,684 veterans died by suicide. Slightly less than half (about 47 percent) of those who died by suicide had at least one psychiatric diagnosis. Having any mental illness diagnosis — no matter what it is — was associated with a higher risk for suicide.
Overall, the least common diagnosis — bipolar disorder — was more strongly associated with suicide than any other condition. Bipolar disorder was diagnosed in 9 percent of those who died by suicide.
“In men, the risk of suicide was greatest for those with bipolar disorder, followed by depression, substance use disorders, schizophrenia, other anxiety disorders and PTSD,” the authors write.
“In women, the greatest risk of suicide was found in those with substance use disorders, followed by bipolar disorder, schizophrenia, depression, PTSD and other anxiety disorder.”
“This makes bipolar disorder particularly appropriate for targeted intervention efforts or attempts to improve medication adherence,” the authors write.
“In all likelihood, many individuals with psychiatric disorders who were at risk for suicide were not identified by the treatment system,” the authors conclude.
“This could be owing to stigma, which may have made individuals less likely to report their mental health symptoms to physicians, an effect that could be more pronounced among men with military experience. These findings highlight the importance of improved identification, diagnosis and treatment of psychiatric diagnoses (particular bipolar disorder, depression, substance use disorders and schizophrenia) of all health care system users.”
The Veterans Affairs Healthcare System is the largest single healthcare system in the country, and recent research indicates veterans have an elevated risk of suicide when compared to the general population.
An estimated 90 percent to 98 percent of individuals who die from suicide meet criteria for at least one psychiatric disorder, according to background information in the article.
“Prior research has consistently found associations between psychiatric conditions (e.g., depression, bipolar disorder, posttraumatic stress disorder [PTSD], schizophrenia and alcohol and/or drug use disorders) and risk of fatal and non-fatal suicide attempts,” the authors write.
The study appears in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals.