Comparison of VA intentional and unintentional deaths.
This retrospective clinical study contrasts 22 unintentional ('accidental') deaths with 31 intentional (suicide) deaths of patients obtaining psychiatric care in a mid-sized VA Health Care system during 1993-1998. Unintended deaths were more frequently associated with addicting agents, particularly opioids. The number of such incidents increased from 1993-1998, a phenomenon that appeared to be associated with the implementation of managed care. These findings challenge rapidly changing psychiatric care systems to generate more effective treatment methods for dangerous addiction pathology despite decreasing numbers of substance abuse personnel per patient.
Barglow
Peter
P
Department of Psychiatry, University of California Medical School at Davis, California 94704, USA. pbarglow@ix.netcom.com
D000059:Accidents / Q000401:mortality* / Q000706:statistics & numerical data; D000368:Aged; D002140:California / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D003155:Community Mental Health Centers / Q000706:statistics & numerical data*; D017831:Diagnosis, Dual (Psychiatry); D039721:Diagnostic and Statistical Manual of Mental Disorders; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000639:trends; D001523:Mental Disorders / Q000453:epidemiology / Q000401:mortality / Q000523:psychology; D008875:Middle Aged; D010561:Personnel Staffing and Scheduling / Q000592:standards; D011569:Psychiatric Status Rating Scales; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000401:mortality / Q000523:psychology; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D014481:United States; D014493:United States Department of Veterans Affairs; D000078329:Workforce; D000092864:Suicide Prevention