摘要：Objectives. We sought to examine rates of suicide among individuals receiving health care services in Veterans Health Administration (VHA) facilities over an 8-year period. Methods. We included annual cohorts of all individuals who received VHA health care services from fiscal year (FY) 2000 through FY 2007 (October 1, 1999–September 30, 2007; N = 8 855 655). Vital status and cause of death were obtained from the National Death Index. Results. Suicide was more common among VHA patients than members of the general US population. The overall rates of suicide among VHA patients decreased slightly but significantly from 2000 to 2007 ( P < .001). Male veterans between the ages of 30 and 64 years were at the highest risk of suicide. Conclusions. VHA health care system patients are at elevated risk for suicide and are appropriate for suicide reduction services, although the rate of suicide has decreased in recent years for this group. Comprehensive approaches to suicide prevention in the VHA focus not only on recent returnees from Iraq and Afghanistan but also on middle-aged and older Veterans. Reducing suicide within the United States is a national priority. 1,2 Over 30 000 individuals in the US die by suicide every year, with an annual age-adjusted rate of approximately 11 suicides per 100 000 persons. 3 Recent public and policy attention has focused on suicide among veterans generally and among individuals receiving services from the Veterans Health Administration (VHA). VHA patients are more likely to have characteristics related to higher risk of suicide, including older age, male gender, and substantial medical and psychiatric morbidities. 4,5 Recent studies provide inconsistent information regarding the relative risk of suicide in veterans. Kaplan et al. 6 found that male veterans who responded to the US National Health Interview Survey were twice as likely to report a suicide attempt as nonveteran males. Additionally, McCarthy et al. 7 found that, compared with rates for the general US population, suicide rates of VHA users in 2000 to 2001 were 1.66 times higher in men and 1.87 times higher in women. By contrast, other studies of specific cohorts of Veterans have failed to find that the risk of suicide is substantially higher than that found in the general population, except within specific high-risk subgroups (e.g. veterans with a mental disorder). 8–14 Similarly, a recent large-scale study of older men found that Veteran status did not significantly increase suicide risk. 15 Research regarding changes over time in suicidal behaviors is also limited. Kessler et al. 16 found that rates of nonfatal suicide attempts did not change over nearly 2 decades. In the general US population, suicide rates increased 2%–3% from 1999 through 2005. 17 However, changes in suicidal behaviors observed in the general population may not apply to Veterans generally and to high-risk individuals receiving VHA services in particular, who may be more accessible for suicide prevention efforts. Monitoring suicide rates among Veterans is also important because of concerns regarding the impact of the conflicts in Iraq (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]). OEF/OIF Veterans have elevated rates of psychiatric and substance use disorders, 18–21 and Congress has mandated implementation of a comprehensive VHA suicide prevention program, which began in 2007. 22 However, a 2008 report observed that suicide rates among OEF/OIF Veterans were not greater than those among the general population. 13 Better data are needed to examine whether suicide rates among VHA patients have changed since the start of the wars in Iraq and Afghanistan, as well as to assess the general stability of rates among patients receiving health care in the VHA, which is the largest integrated health system in the United States. Data on trends in suicide rates among VHA patients also would provide a baseline for assessing the potential impact of initiatives designed to reduce suicide risk. Our study documents potential changes in the rates of suicide among all male and female users of VHA services between fiscal years (FYs) 2000 and 2007. Yearly rates of suicide in Veterans seeking treatment at the VHA were also compared with rates of suicide within the general US population over this time period, both overall and within demographic subgroups defined by age and gender. Based on prior research of Veterans receiving VHA services, 7 we hypothesized that the rate of suicide would be elevated among VHA patients compared with the general population.
