COUNTERING MILITARY RECRUITMENT
Articles: Leaving Military: Veterans
Younger Veterans at Greater Suicide Risk
E.J. Mundell, Healthday
Oct 31, 2007
TUESDAY,
Oct. 30 (HealthDay News) -- A study of U.S. veterans suffering from
depression finds that their risk factors for suicide differ in
surprising ways from those of other depressed Americans.
Specifically, the risk for suicide appears highest among younger
veterans -- the reverse of what's seen in the general population.
And even though post-traumatic stress disorder (PTSD) can be deeply
mentally distressing, veterans suffering with the disorder were
actually less prone to suicide than those not afflicted by the
condition.
The reasons for that remain unclear, the study authors said.
"It's possible that people with PTSD may be receiving additional
services, they may have a greater connection to the VA health system --
more psychotherapy visits, for example," said lead researcher Kara
Zivin, a Veterans Administration investigator and assistant professor
of psychiatry at the University of Michigan at Ann Arbor.
Her team published its findings Tuesday in the online edition of the American Journal of Public Health.
Military service comes with special challenges, and the 1999 Veterans
Health Study found that nearly a third -- 31 percent -- of veterans
were suffering depressive symptoms, a rate that's two to five times
higher than observed in the general public.
Now, as a new generation of soldiers returns from Iraq and Afghanistan,
Zivin's team sought to better understand the risks depressed veterans
face for suicide. To do so, they pored through data from the VA's
National Registry for Depression for the years 1999 to 2004.
Overall, the researchers looked at information on almost 808,000
veterans diagnosed with depressive symptoms; 1,683 (0.21 percent) of
those veterans took their own lives.
The researchers compared the characteristics of the depressed veterans
who committed suicide against the characteristics of those who did not.
Dividing veterans into three groups by age -- 18 to 44 years, 45 to 64
years, and 65 or over -- Zivin's team found that the youngest group was
at higher risk of suicide. Veterans aged 18 to 44 committed suicide at
a rate of about 95 suicides per every 100,00 person years, versus about
78 per 100,000 person years in the group aged 45 to 64, and 90 per
100,000 for those 65 or older.
That findings are at odds with suicide trends among the general
population, where younger depressed people are typically at lower risk
than older individuals, the researchers said.
Zivin said the finding for veterans "wasn't what we expected, and our
data doesn't allow us to figure out why that happened." She also said
the finding should serve as a heads-up to doctors that a veteran's
youth does not make him or her any less of a risk for suicide -- and
might even add to the risk.
Dr. Marcia Valenstein, senior author of the study and an assistant
professor in the department of psychiatry at the University of
Michigan, added, "Clinicians have to be aware that they can't simply
rely on the predictors of suicide in the general population -- in this
depression treatment population, it is the younger individuals who are
most at risk rather than the older individuals. "
Another surprise finding was that a diagnosis of PTSD actually helped
protect veterans against suicide. Depressed veterans with PTSD had a
suicide rate of about 68 per 100,000 person years, the study found,
while the rate was much higher in veterans without the disorder --
almost 91 suicides per 100,000 person years.
That finding was also a bit of a puzzle, Zivin said. She speculated
that PTSD may encourage affected depressed veterans to more readily
seek out psychiatric care.
Another expert agreed.
"The VA system is now much more accepting of looking out for, and
hearing about, PTSD -- it's on the tip of everyone's tongue," said Dr.
Charles Goodstein, a psychiatrist at the New York University Medical
Center and professor of medicine at the NYU School of Medicine.
Compared to depression, PTSD "has become a more acceptable set of
symptoms with which a person can present himself," said Goodstein, who
is also a co-founder of a nonprofit, free mental health outreach
program aimed at veterans called The Soldiers Project
(www.thesoldiersproj ect.org).
"So, both the doctor's antenna is up [for PTSD], and the vet is more
likely to be able to bring it to the doctor's attention, because there
won't be such a stigma connected to it as there might be with
depression," he said. As the PTSD patient receives needed care, his or
her risk for suicide should decline, Goodstein said.
Similarly, the study found that depressed veterans with any physical
disability were also at lowered risk for suicide -- possibly because
they, too, saw doctors more often.
Other risk factors for suicide mirrored those seen in the general
population. Veterans struggling with depression were much more likely
to kill themselves if they were also battling substance abuse, the
study found. Depressed male veterans were about three times as likely
to kill themselves compared to females, and whites were at higher risk
than blacks or Hispanics.
Due to a lack of data, the study was not able to assess the impact of
specific military activity, such as active combat, on risks for
depression and suicide.
The real challenge, experts agreed, is to make sure that all veterans struggling with depression get the care they need.
Certain VA centers "are beginning to set up what's called a Suicide
Attempts Registry so that they can follow veterans who are at higher
risk," said Gregory K. Brown, a specialist in these issues.
"I think having registries that follow up on high-risk veterans is one
of the ways to go," said Brown, a research associate professor in the
department of psychiatry at the University of Pennsylvania.
The VA has also set up a special suicide hotline specifically aimed at veterans, accessed toll-free at
1-800-273-TALK.
Still, some improvements could be made, Brown added.
"While the VA have both mental health programs set up and substance
abuse programs, they need to have ways of merging the two programs so
that veterans who have both disorders get [coordinated] treatment," he
said.
A veteran's family and friends can help, too.
"Families should take any comments about suicide or 'life is not worth
living' seriously," Brown said. "They shouldn't pass it off as just
somebody being upset."
Zivin agreed.
"The key thing is to talk to people," she said. "It's hard to know without conversation what someone is thinking."
More information
For more about suicide and depression, visit the American Association of Suicidology.
SOURCES: Kara Zivin, Ph.D., Veterans Administration investigator, and
assistant professor, department of psychiatry, University of Michigan,
Ann Arbor; Marcia Valenstein, M.D., assistant professor in the
department of psychiatry, University of Michigan, Ann Arbor; Charles
Goodstein, M.D., psychiatrist, New York University Medical Center, and
professor, medicine, NYU School of Medicine, New York City; Gregory
Brown, Ph.D., resear
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