Violent and nonviolent suicide in veterans with substance-use disorders.
OBJECTIVE
Substance-use disorders (SUDs) increase the risk of suicide. Examining risk factors for violent or nonviolent suicide in those with SUDs could improve suicide-prevention efforts in these individuals. We examined the demographic and clinical predictors of violent and nonviolent suicide among patients with SUDs.


METHOD
This study examined Veterans Affairs (VA) patients with SUDs who were alive at the beginning of Fiscal Year (FY) 2002 and died by suicide during FYs 2002 through 2006 (n = 854) and a random sample of 4,228 SUD patients who did not die by suicide during this period. Data were obtained from VA medical records and the National Death Index. Patients were considered to have an SUD if they received two or more diagnoses of the same SUD from FY 1997 to FY 2001.


RESULTS
Of those who died by suicide, 70% (n = 600) used violent means. Diagnoses of depressive, other anxiety, bipolar and posttraumatic stress disorders, schizophrenia, and personality disorders were associated with increased risk of both violent and nonviolent suicide; however, these associations were stronger for nonviolent than violent suicide deaths. Risk of nonviolent suicide was greater among patients with opioid-use disorders or a clinical diagnosis of abuse or dependence (according to the International Classification of Diseases, Tenth Revision) on multiple substances.


CONCLUSIONS
Most VA patients with SUDs who died from suicide used violent means. No specific SUD was associated with increased risk of violent suicide, but several SUD diagnoses were associated with increased risk of nonviolent suicide. Concurrent psychopathology increased risk for both suicide types; however, the relationship was strongest for nonviolent suicide.