Psychopathology, Iraq and Afghanistan Service, and Suicide among Veterans Health Administration Patients

Objective: Despite concerns regarding elevated psychiatric morbidity and suicide among veterans returning from Operations Enduring Freedom and Iraqi Freedom (OEF/OIF), little is known about the impact of psychiatric conditions on the risk of suicide in these veterans. To inform tailored suicide prevention efforts, it is important to assess interrelationships between OEF/OIF status, psychiatric morbidity, and suicide mortality. This study sought to examine potential associations between OEF/OIF status and suicide mortality among individuals receiving care in the Department of Veterans Affairs health system, the Veterans Health Administration (VHA). Analyses assessed potential interactions between OEF/OIF status and psychiatric conditions as predictors of suicide. Method: Analyses included data for all individuals who received VHA services during fiscal year (FY) 2007 or FY08 and were alive at the start of FY08 (N = 5,772,282). Results: For this cohort, there were 1,920 suicide deaths in FY08, including 96 among OEF/OIF veterans. Controlling for demographic factors, psychiatric conditions, OEF/OIF status, and the interaction between psychiatric conditions and OEF/OIF status, no main effects of OEF/OIF status were observed. However, a significant interaction was found between psychiatric conditions and OEF/OIF status. Specifically, having a diagnosed mental health condition was associated with a greater risk of suicide among OEF/OIF veterans (hazard ratio [HR] = 4.41; 95% confidence interval [CI]: 2.57, 7.55; p less than 0.01) than among non-OEF/OIF veterans (HR = 2.48; 95% CI [2.27, 2.71]; p less than 0.01). Conclusion: These findings highlight the importance of mental health screening and intervention for OEF/OIF veterans. (Contains 4 tables and 1 figure.)