The role of PTSD in suicide death and lethal means among veterans with substance use disorders

Suicide is a leading cause of death among veterans. Suicide method or means significantly affects lethality rates and intervention strategies. Among veterans, posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are highly prevalent and are significant risk factors for suicide.

Examine the potential compounding associations of co-occurring PTSD among veterans with opioid (OUD) and/or alcohol use disorder (AUD) on lethal means among suicide decedents.

We analyzed nationwide Veterans Health Administration electronic health record and mortality data from the VA Mortality Data Repository for veterans with AUD and/or OUD who died from January 1, 2016-December 31, 2021. Suicide deaths were identified using ICD-10 codes for intentional self-harm. Lethal means were classified using the CDC injury mortality diagnosis matrix.

Among 158,818 deceased veterans (3870 suicide decedents), 24.25% were diagnosed with PTSD. Veterans with PTSD who died by suicide were significantly more likely to be diagnosed with other mental disorders than those without PTSD. The most common suicide methods were firearms (61%), suffocation (20%), and drug-related poisoning (10%). Veterans with PTSD were less likely to die by firearm suicide but more likely to die by poisoning or suffocation compared to those without PTSD. Multivariate models indicated that psychiatric comorbidity, beyond PTSD, significantly modified these associations.

Findings underscore the importance of understanding the interplay between PTSD, SUD, and psychiatric comorbidities in suicide means selection among veterans. Tailored interventions for overdose prevention and comprehensive psychiatric care are critical for reducing suicide mortality among veterans with differing risk profiles.