Abstract
Objectives
To examine risk factors in the year before suicide in a national sample of United
States veterans with multiple sclerosis (MS), as well as means of suicide and receipt
of mental health services prior to death.
Design
Case control study. Individuals in the Veterans Affairs MS National Data Repository
were linked to the National Death Index Plus to obtain death records, including specific
causes of death. Participants were veterans with MS who died by suicide and randomly
selected nonsuicide MS controls (5 per participant) who were alive at the time of
the index suicide. Mental health disorders and medical comorbidities were identified
in the year before death for suicides and during the identical time period for controls.
Setting
Veterans Health Administration.
Participants
Veterans (N=426) who received treatment for MS in the United States Veterans Health
Administration between 1999 and 2011. There were 71 deaths by suicide and 355 randomly
selected controls.
Interventions
Not applicable.
Main Outcome Measure
Suicide.
Results
Results from the adjusted multivariable model suggest that the following factors were
associated with an increased risk for suicide: male sex (odds ratio [OR], 3.60; 95%
confidence interval [CI], 1.35-9.42), depression (OR, 1.82; 95% CI, 1.03-3.23), and
alcohol use disorder (OR, 3.10; 95% CI, 1.38-6.96). Half (50.7%) had a mental health
appointment in the year before suicide. The primary means of suicide was by firearm
(62.0%).
Conclusions
Routine assessment of suicide risk in individuals with MS is warranted, particularly
for those with recent history of depression or alcohol use disorder.
Keywords
List of abbreviations:
CI (confidence interval), ICD-9 (International Classification of Diseases, Ninth Revision), MS (multiple sclerosis), OR (odds ratio), PTSD (posttraumatic stress disorder), VHA (Veterans Health Administration), VA (Veterans Affairs)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 20, 2020
Footnotes
Supported by the VA MS Center of Excellence West. The views expressed are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
Support for this research was provided by the Veterans Administration Multiple Sclerosis Center of Excellence West.
Disclosures: none.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
