title: Substance use disorders and the risk of suicide mortality among men and women in the US Veterans Health Administration.
abstract: OBJECTIVE
  Limited information is available regarding links between specific substance use disorders (SUDs) and suicide mortality; however, the preliminary evidence that is available suggests that suicide risk associated with SUDs may differ for men and women. This study aimed to estimate associations between SUDs and suicide for men and women receiving Veterans Health Administration (VHA) care.
  
  
  METHODS
  A cohort study using national administrative health records.
  
  
  METHODS
  National VHA system, USA.
  
  
  METHODS
  All VHA users in fiscal year (FY) 2005 who were alive at the beginning of FY 2006 (n = 4 863 086).
  
  
  METHODS
  The primary outcome of suicide mortality was assessed via FY 2006-2011 National Death Index (NDI) records. Current SUD diagnoses were the primary predictors of interest, and were assessed via FY 2004-2005 VHA National Patient Care Database (NPCD) records.
  
  
  RESULTS
  In unadjusted analyses, a diagnosis of any current SUD and the specific current diagnoses of alcohol, cocaine, cannabis, opioid, amphetamine and sedative use disorders were all associated significantly with increased risk of suicide for both males and females [hazard ratios (HRs)] ranging from 1.35 for cocaine use disorder to 4.74 for sedative use disorder for men, and 3.89 for cannabis use disorder to 11.36 for sedative use disorder for women]. Further, the HR estimates for the relations between any SUD, alcohol, cocaine and opioid use disorders and suicide were significantly stronger for women than men (P < 0.05). After adjustment for other factors, most notably comorbid psychiatric diagnoses, associations linking SUDs with suicide were attenuated markedly and the greater suicide risk among females was observed for only any SUD and opioid use disorder (P < 0.05).
  
  
  CONCLUSIONS
  Current substance use disorders (SUDs) signal increased suicide risk, especially among women, and may be important markers to consider including in suicide risk assessment strategies. None the less, other co-occurring psychiatric disorders may partially explain associations between SUDs and suicide, as well as the observed excess suicide risk associated with SUDs among women.
authors.affiliation: Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA.|Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kipling M
authors.initials: KM
authors.lastname: Bohnert
authors.affiliation: Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA.|Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ilgen
authors.affiliation: Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Ann Arbor, MI, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Louzon
authors.affiliation: Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA.|Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.|Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Ann Arbor, MI, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: McCarthy
authors.affiliation: Department of Veterans Affairs, Office of Mental Health Services, Washington, DC, USA.
authors.forename: Ira R
authors.initials: IR
authors.lastname: Katz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Alcohol use disorder; Veterans Health Administration; cohort; drug use disorders; substance use disorders; suicide