摘要：Objectives. We sought to describe the extent and nature of contact with the health care system before suicide among veterans with substance use disorders (SUDs). Methods. We examined all male Veterans Health Administration patients who died by suicide between October 1, 1999, and September 30, 2007, and who had a documented SUD diagnosis during the 2 years before death (n = 3132). Results. Over half (55.5%; n = 1740) of the male patients were seen during the month before suicide, and 25.4% (n = 796) were seen during the week before suicide. In examining those with a medical visit in the year before suicide (n = 2964), most of the last visits before suicide (56.6%; n = 1679) were in a general medical setting, 32.8% (n = 973) were in a specialty mental health setting, and 10.5% (n = 312) were in SUD treatment. Conclusions. Men with SUDs who died from suicide were frequently seen in the month before their death. Most were last seen in general medical settings, although a substantial minority of those with SUDs was seen in specialty mental health settings. Suicide represents a major public health concern. 1 Over 30 000 suicides occur in the United States each year, and suicide is a leading cause of death and years of potential life lost among Americans aged 18 to 65 years. 2 Individuals with substance use disorders (SUDs) are at high risk for suicidal behaviors, including suicide attempts and fatal suicides. 3–5 For example, survey data indicate that the risk of lifetime suicide attempt is nearly 6 times greater among individuals with SUDs than among the general population. 4 Data from SUD treatment settings also indicate that individuals treated for cocaine dependence, 6 opiate dependence, 7 and various other SUDs 8–10 have high lifetime prevalence rates of suicide attempts. Data on suicide mortality show similar results, including cohort studies showing that individuals treated for alcohol, opiate, intravenous drug, and stimulant use disorders are at high risk for eventual suicide 5 and controlled postmortem studies showing that alcohol and other SUDs confer risk for suicide. 11 Moreover, alcohol use disorders are the second most prevalent disorders among suicide decedents, following only mood disorders. 12 Existing evidence indicates that between 24% and 69% of suicide decedents contact a health care professional during the month before suicide, with 23% to 47% having a health care contact in the week before suicide. 13–19 However, relatively little is known about how individuals with SUDs interact with the health care system before suicide. Understanding which SUD patients may be at heightened risk for suicide, as well as treatment patterns before suicide, is essential to develop effective interventions to prevent suicide among this large at-risk population. The goals of this study were 2-fold. First, we aimed to describe the demographic and clinical characteristics of male patients with SUDs who died by suicide, as well as the nature of their contacts with the health care system during the year before suicide. The decision was made to focus on male patients because of concerns about low numbers of female patients utilizing Veterans Health Administration (VHA) services. Second, we examined the factors associated with the setting of care on the last visit before suicide. Such information was needed to aid in the development of more precise risk models for suicide among male patients with SUDs and to identify promising service contact points for suicide prevention interventions.
