With Depression, Vets Face Higher Suicide Risk

By Steven Reinberg
HealthDay Reporter
Monday, January 12, 2009; 12:00 AM

MONDAY, Jan. 12 (HealthDay News) -- About a third of the veterans treated in Veterans Affairs hospitals suffer from depression, putting them at much greater risk of suicide than non-depressed veterans, University of Michigan researchers report.

But is that risk greater at certain times, and might it be related to their use of antidepressants, the researchers wondered?

Their five-year study of veterans with depression revealed a spike in suicide risk after discharge from a psychiatric hospital and a relatively short-term increase in risk after beginning treatment with an antidepressant. The findings were published in the January issue of the Journal of Affective Disorders.

"The goal of this study was to determine suicide rates during potentially high risk periods for patients with depressive disorders," said lead researcher Dr. Marcia Valenstein, a clinical psychiatrist at the VA Ann Arbor Healthcare System and an associate professor of psychiatry at the University of Michigan Health System.

Valenstein's research team collected data on 887,859 VA hospital patients being treated for depression from April 1999 to September 2004. They calculated the suicide rate for several 12-week periods, including after the start of treatment with antidepressants, after treatment changes, and upon discharge from a psychiatric hospital.

"The possibility of increased suicide risks with antidepressant use has received much media attention, and there have been governmental recommendations for close clinical monitoring during these periods," Valenstein said.

The study confirmed what others have shown: that the first 12 weeks after starting antidepressants is a higher risk period for patients, with 210 suicides per 100,000 person-years, but that the risk returns to normal thereafter.

"However, patients were at very high risk for suicide immediately following psychiatric hospitalizations, where the suicide rate was 568 per 100,000 person-years," Valenstein said. The risk for suicide after psychiatric hospitalization does not return to normal for a year, she said.

Veterans 61 to 80 years of age were found to have the highest risk of suicide, the researchers noted.

There are currently no governmental recommendations for close monitoring after someone is discharged from a psychiatric hospital, although one widely used protocol suggests one visit in the first seven days after discharge, Valenstein said.

"To have the greatest impact on suicide, health systems should prioritize suicide prevention efforts following psychiatric hospitalizations," she said. "If resources allow, closer monitoring during the first 12 weeks after an antidepressant start may be warranted."

Valenstein said that to help stem the tide of suicide among veterans, the Department of Veterans Affairs is spending $300 million for suicide prevention and other mental health services.


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