Clinical Topics   /   Psychiatry

Improved Schizophrenia Control May Be Essential in Reducing VA Suicide Rate

USM By U.S. Medicine
August 1, 2011

Suicide among veterans has grabbed its fair share of headlines in recent weeks. Much of the focus has been on VA’s difficulty in providing timely care, especially to veterans returning from deployment with PTSD, TBI or other neuropsychological conditions.

What has largely been overlooked is that VA provides care to about 170,000 veterans with schizophrenia and bipolar disorder; schizophrenia  carries with it an extremely high risk of suicide. Suicide attempts in that population are estimated to occur in between 20% and 50% of cases.

In defending against a recent ruling by the 9th U.S. Circuit Court of Appeals that veterans may look to the courts to seek relief from their claims that VA failed to provide them adequate or timely care, VA officials noted it had recently hired 3,500 more mental health professionals, bringing the total to 21,000 throughout the system. They also asserted that VA has a 95% success rate in meeting its goal of fully evaluating veterans who are not in crisis and seeking mental health care within 14 days.

The problem is that access to treatment in and of itself may not adequately address the problem, especially when serious mental health conditions are involved.

As noted in a study by Lauren Denneson, PhD, and colleagues, who researched 112 suicides by veterans from 2000 to 2005, all of the veterans had some contact with the VA health system in the year before they died.1 

Better Schizophrenia Treatment           

One answer to the problem may be improving treatment of schizophrenia, which is a leading cause of suicide, experts say.

In a study last year by Mark Ilgen, PhD, an assistant professor of psychiatry at the University of Michigan Medical School and a research investigator at the Department of Veterans Affairs’ National Serious Mental Illness Treatment Research and Evaluation Center in Ann Arbor, MI, and colleagues, schizophrenia was identified as a greater risk factor in suicide in veterans than PTSD. And while at first glance it appeared to be a lesser risk factor than substance abuse, bipolar disorder and depression, since those conditions are often seen as co-morbidities with schizophrenia the importance of the role the disease plays in suicide appears even greater.

“Prior research established a link between schizophrenia and suicide, and this association also appears to be present in VA patients,” says Ilgen. He adds that his research team found that, for the study population — veterans receiving health care within the VA system at the time of the study — men with schizophrenia were approximately twice as likely to die by suicide and women with schizophrenia were almost six times more likely to die from suicide than those without the disease.

In addition, the researchers noted in the study, men with bipolar disorder and women with substance use disorders were found to be at particularly elevated risk for suicide. In all, they noted, in the seven years after FY 1999, 7,684 veterans died by suicide.

“More research is needed to better understand the factors that may increase or lower suicide risk in VA patients,” Ilgen adds.


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