Comorbid depression and alcohol use disorders and prospective risk for suicide attempt in the year following inpatient hospitalization.
OBJECTIVE
The purpose of this study is to identify predictors of nonfatal suicide attempts in veterans discharged from acute hospitalization with depression and/or alcohol use disorder (AUD) diagnoses. We hypothesized that primary depression confers similar risk for attempt whether or not it is accompanied by secondary AUD, and that a suicide attempt in the prior year would confer greatest risk of the variables studied.


METHODS
Veteran Health Administration (VHA) patients discharged from acute inpatient hospitalization in 2011 with AUD and/or non-bipolar depression diagnoses (N=22,319) were analyzed using information from the computerized record system and national database on suicidal behavior. Proportional hazard regression models estimated unadjusted and adjusted hazard ratios (AHR) and confidence intervals (95% CI) for risk of a nonfatal attempt within one year following discharge.


RESULTS
As hypothesized, primary depression with secondary AUD [AHR (95% CI)=1.41 (1.04, 1.92)] and without secondary AUD [AHR (95% CI)=1.30 (1.00, 1.71)] conferred similar prospective risk for attempt (AUD without depression, reference). Although prior suicide attempt was associated with increased risk, acute care in "general psychiatry" during hospitalization [AHR (95% CI)=6.35 (3.48, 13.00)] conferred the greatest risk among the variables studied. Transfer to another inpatient setting reduced risk [AHR (95% CI=0.53 (0.34, 0.79).


CONCLUSIONS
Analyses were based on administrative data and did not include information on mortality.


CONCLUSIONS
When primary depression is severe enough to warrant inpatient hospitalization, a secondary diagnosis of AUD may not contribute additional prospective risk for nonfatal attempt. Within VHA, acute psychiatric care during hospitalization is a potential marker for increased risk for nonfatal attempt. Transfer to an additional inpatient setting may reduce risk for nonfatal attempt.
VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: peter.britton@va.gov.
Peter C
PC
Britton
VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, USA.
Brady
B
Stephens
VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, USA.
Jing
J
Wu
VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, USA.
Cathleen
C
Kane
VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Autumn
A
Gallegos
VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Lisham
L
Ashrafioun
VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Xin
X
Tu
VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Kenneth R
KR
Conner
D000368:Aged; D019973:Alcohol-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*
Alcoholism; Depression; Inpatients; Suicide, attempted; Veterans