Younger Veterans at Greater Suicide Risk

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.thesoldiersproject.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., research associate professor, department of Psychiatry, University of Pennsylvania, Philadelphia; Oct. 30, 2007,American Journal of Public Health, online