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This Article Full Text Full Text (PDF) All Versions of this Article: AJPH.2007.115477v1 97/12/2193    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Zivin, K. Articles by Valenstein, M. PubMed PubMed Citation Articles by Zivin, K. Articles by Valenstein, M. Related Collections Mental Health Mortality

Kara Zivin, PhD, H. Myra Kim, PhD, John F. McCarthy, PhD, Karen L. Austin, MPH, Katherine J. Hoggatt, PhD, Heather Walters, MS and Marcia Valenstein, MD, MS

Kara Zivin is with the Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Health Services Research and Development (HSR&D) Center of Excellence, Department of Veterans Affairs, Ann Arbor, Mich, and the Department of Psychiatry, University of Michigan Medical School, Ann Arbor. H. Myra Kim is with the Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor. John F. McCarthy is with the SMITREC, HSR&D Center of Excellence, Department of Veterans Affairs, Ann Arbor, and the Department of Psychiatry, University of Michigan Medical School, Ann Arbor. Karen L. Austin is with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor. Katherine J. Hoggatt is with the Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor. Heather Walters is with the SMITREC, HSR&D Center of Excellence, Department of Veterans Affairs, Ann Arbor. Marcia Valenstein is with the SMITREC, HSR&D Center of Excellence, Department of Veterans Affairs, Ann Arbor, and the Department of Psychiatry, University of Michigan Medical School, Ann Arbor.

Correspondence: Requests for reprints should be sent to Kara Zivin, PhD, Depression Center, 4250 Plymouth Rd, Box 5765, Ann Arbor, MI 48109 (e-mail: kzivin{at}umich.edu).

Objectives. We sought to report clinical and demographic factors associated with suicide among depressed veterans in an attempt to determine what characteristics identified depressed veterans at high risk for suicide.

Methods. We used longitudinal, nationally representative data (1999–2004) to determine suicide rates among depressed veterans, estimating time until suicide using Cox proportional hazards regression models.

Results. Of 807694 veterans meeting study criteria, 1683 (0.21%) committed suicide during follow-up. Increased suicide risks were observed among male, younger, and non-Hispanic White patients. Veterans without service-connected disabilities, with inpatient psychiatric hospitalizations in the year prior to their qualifying depression diagnosis, with comorbid substance use, and living in the southern or western United States were also at higher risk. Posttraumatic stress disorder (PTSD) with comorbid depression was associated with lower suicide rates, and younger depressed veterans with PTSD had a higher suicide rate than did older depressed veterans with PTSD.

Conclusions. Unlike the general population, older and younger veterans are more prone to suicide than are middle-aged veterans. Future research should examine the relationship between depression, PTSD, health service use, and suicide risks among veterans.