摘要：Objectives. Our objective was to examine all suicides (n = 423) in 2 geographic areas of the Veterans Health Administration (VHA) over a 7-year period and to perform detailed chart reviews on the subsample that had a VHA visit in the last year of life (n = 381). Methods. Within this sample, we compared a group with 1 or more documented psychiatric symptoms (68.5%) to a group with no such symptoms (31.5%). The groups were compared on suicidal thoughts and behaviors, somatic symptoms, and stressors using the χ2 test and on time to death after the last visit using survival analyses. Results. Veterans with documented psychiatric symptoms were more likely to receive a suicide risk assessment, and have suicidal ideation and a suicide plan, sleep problems, pain, and several stressors. These veterans were also more likely to die in the 60 days after their last visit. Conclusions. Findings indicated presence of 2 large and distinct groups of veterans at risk for suicide in the VHA, underscoring the value of tailored prevention strategies, including approaches suitable for those without identified psychiatric symptoms. Suicide is the eleventh leading cause of death in the United States and the fifth leading cause of years of potential life lost before age 65 years. 1 Prevention efforts must include a focus on veterans who use Veterans Health Administration (VHA) services. 2 The VHA is the largest health care system in the United States, and each year more than 1800 veterans using VHA services die by suicide, 3 representing 5% to 6% of all suicides in the United States annually. Moreover, compared with the general US population, rates of suicide in veterans using VHA services are estimated to be 1.66-times higher (95% confidence interval [CI] = 1.58, 1.74) among men and 1.87-times higher (95% CI = 1.35, 2.47) among women. 3 In a recent, national study of veterans who used VHA services, depression, bipolar disorder, posttraumatic stress disorder (PTSD), schizophrenia, and alcohol or drug use disorders were associated with increased risk of suicide, 4 which was congruent with findings in the general literature. 5,6 Interestingly, slightly less than half (i.e., 46.8%) of VHA patients who killed themselves were diagnosed with a mental disorder. The study was based on clinician diagnoses, and greater psychopathology would have undoubtedly been uncovered using research interviews. Nonetheless, the study indicated that a large proportion of VHA patients who killed themselves did not have documented (or recorded) symptoms of psychopathology. Suicide decedents who receive psychiatric treatment differ from those who do not in demographics, diagnoses, and the type of stressors they experience, 7–9 suggesting that there are likely to be important differences between decedents with and without recorded psychiatric symptoms. These findings have implications for prevention and suggest the potential need for universal strategies to reduce risk for suicide in the group without documented psychiatric symptoms. Additionally, the differences between those with and without documented psychiatric symptoms are likely to extend to patterns of service use before death, with those reporting more symptoms making greater contact with the health care system and, thus, potentially having a shorter time to death after their last visit. The purpose of our study was to compare 2 broad groups of users of VHA services who died by suicide, a group with clinician-documented psychiatric symptoms (i.e., depression, anxiety, alcohol use disorders, drug use disorders, schizophrenia, and mania) in the last year of life, and a group with no documented symptoms. Using systematic chart reviews, we examined differences in sociodemographic characteristics, suicide-related variables (i.e., received a suicide risk assessment, suicidal ideation, suicide plan, suicide attempt), treatment contacts (i.e., received care from a mental health professional), somatic symptoms (i.e., sleep, pain), and specific stressors (i.e., occupational, relational, housing, legal) in the last year of life and at the last visit (when data were available), as well as time to death after the last visit. We hypothesized that the medical records of the group with recorded symptoms would also be more likely to show suicide-related variables, somatic symptoms, and stressors. We also explored time to death in the 2 study groups.
