Comorbid depression and alcohol use disorders and prospective risk for suicide attempt in the year following inpatient hospitalization

- We examine predictors of suicide attempts after discharge from hospitalization.
- Study population is veterans with depression and/or alcohol use disorders (AUDs).
- Depression predicts attempts, and comorbid AUDs add little to assessment of risk.
- General psychiatric care is a stronger predictor of attempts than prior attempts.
- Transfer to another inpatient setting reduced risk for an attempt.

Objective: The purpose of this study is to identify predictors of nonfatal suicide attempts in veterans discharged from acute hospitalization with depression and/or alcohol use disorder (AUD) diagnoses. We hypothesized that primary depression confers similar risk for attempt whether or not it is accompanied by secondary AUD, and that a suicide attempt in the prior year would confer greatest risk of the variables studied.Method: Veteran Health Administration (VHA) patients discharged from acute inpatient hospitalization in 2011 with AUD and/or non-bipolar depression diagnoses (N=22,319) were analyzed using information from the computerized record system and national database on suicidal behavior. Proportional hazard regression models estimated unadjusted and adjusted hazard ratios (AHR) and confidence intervals (95% CI) for risk of a nonfatal attempt within one year following discharge.Results: As hypothesized, primary depression with secondary AUD [AHR (95% CI)=1.41 (1.04, 1.92)] and without secondary AUD [AHR (95% CI)=1.30 (1.00, 1.71)] conferred similar prospective risk for attempt (AUD without depression, reference). Although prior suicide attempt was associated with increased risk, acute care in “general psychiatry” during hospitalization [AHR (95% CI)=6.35 (3.48, 13.00)] conferred the greatest risk among the variables studied. Transfer to another inpatient setting reduced risk [AHR (95% CI=0.53 (0.34, 0.79).Limitations: Analyses were based on administrative data and did not include information on mortality.Conclusion: When primary depression is severe enough to warrant inpatient hospitalization, a secondary diagnosis of AUD may not contribute additional prospective risk for nonfatal attempt. Within VHA, acute psychiatric care during hospitalization is a potential marker for increased risk for nonfatal attempt. Transfer to an additional inpatient setting may reduce risk for nonfatal attempt.